Vitreous Haemorrhage

Last updated 20.09.12

 

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Index

 

Definition

-  Haemorrhage of blood into the vitreous humour of the eye

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Features

-  Incidence 0.7%

-  Common cause for acute or subacute vision loss

-  Anticoagulation has not been identified as a risk factor

 

Associated S/S

- Painless unilateral floaters or vision loss

-  Floaters, cobwebs, haze, shadows, red hue

-  Significant haemorrhage limits visual acuity and visual fields

-  Vision may be worse in morning as blood settles over macula

 

Causes

- Abnormal vessels from neovascularisation due to ischaemia

-  Diabetic retinopathy (DM) 30-50%

-  Sickel cell retinopathy

-  Retinal vein occlusion

-  Retinopathy of prematurity (ROP)

-  Occular Ischaemic syndrome

- Rupture of normal vessels

-  Blunt or penetrating trauma 12-19%

-  Most common cause in patients <40yrs

-  Occular surgery

-  Tersons syndrome (secondary to SAH)

- Blood from other sources

-  Retinal microaneurysm

-  Tumours

-  Choroidal neovascularization

-  AMD

 

Complications

- Typically once blood has been in vitreous for 1yr or more

- Haemosiderosis bulbi

- Proliferative vitreoretinopathy: scarring & retinal detachment

- Acute glaucoma

-  Ghost cell glaucoma

-  Haemolytic glaucoma

 

Ix

- Eye Exam

-  Visual acuity

-  Visual fields: reduced if significant size +/- scotomas

- Fundoscopy

-  Dilated examination of unaffected eye for indications of underlying pathology

- +/- Slit Lamp

-  RBCs posterior to lense

 

Mx

- Referral to optomistrist or ophthalmologist for further Ix

-  Indirect ophthalmoscopy

-  Gonioscopy

-  IOP

-  B-Scan US

-  Blood typically cleared at rate of 1% per day

-  F/U to monitor for clearance

-  If retina intact out-pt Mx

-  Vitrectomy

-  If retina detached or has a break

-  Nonclearing haemorrhage

-  Glaucoma

-  Underlying cause

 

 

 

References

 

Vitreous Hemorrhage: Diagnosis & Treatment, EyeNet, 1991, www.aao.org/publications/eyenet/200703/pearls.cfm

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