VITREOUS HEMORRHAGE

INTRODUCTION:
  • It is the extravasation of blood into the areas in and around the vitreous humor of the eye.
  • The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye.
  • Most common complication after lens extraction persistent hyperplastic primary vitreous is Vitreous hemorrhage
ETIOLOGY:
1. Diabetic Retinopathy
  • The most common cause found in adults is diabetic retinopathy.
  • Abnormal blood vessels can form in the back of the eye of a person with diabetes.
  • These new blood vessels are weaker and prone to breaking and causing hemorrhage.
2. Trauma
  • Trauma is the leading cause of vitreous hemorrhage in young people, and accounts for 12-18.8% of cases in adults.
3. Retinal Tear/Detachment
  • A tear in the retina can allow fluids from the eye to leak in behind the retina, which causes retinal detachment.
  • When this occurs, blood from the retinal blood vessels can bleed into the vitreous.
4. Posterior Vitreous Detachment
  • As one gets older, pockets of fluid can develop in the vitreous.
  • When these pockets develop near the back of the eye, the vitreous can pull away from the retina and possibly tear it.
5. Other Causes
  • Proliferative sickle cell retinopathy
  • Macroaneurysm
  • Age-related macular degeneration
  • Terson syndrome
  • Retinal neovascularization as a result of branch or central retinal vein occlusion
Symptoms/Diagnosis
  • Blurry vision
  • In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is Eale's disease
  • Floaters- faint cobweb-like apparitions floating through the field of vision
  • Reddish tint to vision
  • Vitreous hemorrhage produces Sudden painless loss of vision
  • Photopsia-brief flashes of light in the peripheral vision
  • Small vitreous hemorrhage often manifests itself as "floaters".
  • A moderate case will often result in dark streaks in the vision, while dense vitreous hemorrhage can significantly inhibit vision.
Treatments
  • The treatment method used depends on the cause of the hemorrhage.
  • In most cases, the patient is advised to rest with their head elevated 30-45° and sometimes to put patches over the eyes to limit movement prior to treatment in order to allow the blood to settle.
  • The patient is also advised to avoid taking medications that cause blood thinning (such as aspirin or similar medications).
  • Retinal tears are closed by Laser treatment or cryotherapy, and detached retinas are reattached surgically.
  • In cases of vitreous hemorrhage due to detached retina, long standing vitreous hemorrhage with a duration of more than 2-3 months, or cases associated with rubeosis iridis or glaucoma, a vitrectomy may be necessary to remove the standing blood in the vitreous
Exam Question
  • The most common cause of vitreous hemorrhage in adults is Diabetes
  • Causes of floaters in DM is vitreous hemorrhage
  • In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is Eale's disease
  • Trauma is the most common cause of vitreous hemorrhage in young individuals
  • Vitreous hemorrhage is caused commonly by Retinal vein occlusion
  • No treatment is given immediately in vitreous hemorrhage in eye 
  • Vitreous hemorrhage produces Sudden painless loss of vision
  • Most common complication after lens extraction persistent hyperplastic primary vitreous is Vitreous hemorrhage
  • A 40-year old male with diabetes presents with vitreous hemorrhage may be due to Neovascularization at disc
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