Learn the fundamentals in less than 15 minutes
A vitreous hemorrhage refers to a bleed (hemorrhage) within the vitreous cavity. The vitreous cavity is located behind the natural lens of the eye and in front of the retina.
Patients may note new black spots that moves when the eye moves.
Large amounts of hemorrhage may be perceived as large red objects in the vision or cast a reddish tint on light.
The vision may become blurry as the blood is dispersed within the vitreous cavity. This is typically worse in the morning (more on this later).
There are two main causes: Pulling forces on retinal blood vessels and new blood vessel growth (neovascularization)
Posterior vitreous detachment – A seperation of the vitreous (gel) from the back of the eye towards the front of the eye. The gel may pull on the retinal vessels, causing a hemorrhage.
Retinal Tear with or without detachment – The vitreous may pull hard enough that it tears the retina. This may or may not be accompanied by a hemorrhage. This frequently warrants same day evaluation and treatment.
Retinal vascular diseases may cause poor blood flow to the retina. This results in the secretion of a hormone called vascular endothelial growth factor. This hormone causes the formation of abnormal blood vessels which may leak and bleed.
The most common examples include diabetic retinopathy, central retinal vein occlusion, and branch retinal vein occlusion.
The key to the hemorrhage clearing is to allowing the blood to settle along the bottom of the eye using gravity. This will allow the blood to move away from the part of the retina responsible for central vision.
Maintain the head of the bed elevated (sleep with at least 2 pillows or in a recliner)
Avoid bending (causes the blood to disperse again)
Avoid heavy lifting or straining
Avoid high impact activities or fast eye movements (causes dispersion of the blood)
The treatment is focused on two elements: Treating the underlying cause and improving the vision
The eye care specialist will meticulously examine the retina to evaluate for any retinal tears or detachments. Retinal tears are typically treated with an in-office laser procedure. Retinal detachments may be repaired in the office or operating room.
The eye care specialist will typically treat this condition with an in-office laser or intravitreal injections.
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