Vitreous hemorrhage is bleeding into the jelly-like filling of the back part of your eye. This substance is the vitreous humour. It helps the eye keep its shape and is normally clear, allowing light from outside the eye to pass through it to reach the retina.

Vitreous hemorrhage varies in degree from mild (hazy vision) to complete loss of vision. It is painless and it comes on quite quickly. Usually only one eye is affected. Although vitreous hemorrhage can cause a major decrease in vision, once the bleeding has been treated, many cases resolve, and vision is restored. The most common causes of vitreous hemorrhage are trauma and diabetic eye disease.

Vitreous hemorrhage affects about 7 per 100,000 people each year. This makes it one of the most common causes of sudden deterioration in vision. The most common causes, accounting for about 90% of all cases of vitreous hemorrhage are, bleeding from abnormal new blood vessels forming in advanced diabetic eye disease, bleeding from tears in the retina caused by vitreous detachment, trauma to the eye (more common in younger people).

WHAT ARE THE SYMPTOMS OF VITREOUS HEMORRHAGE?

The symptoms of smaller bleeds are floaters, cobwebs, haze and shadows in the eye. There may be a red tint to the vision. Symptoms most commonly affect one eye only, although both eyes can be affected. More severe bleeds cause haziness of vision, sometimes with blind spots or dark streaks.

HOW DO WE MANAGE AND TREAT VITREOUS HEMORRHAGE?

Your Erie Retinal Surgery specialist will dilate your eyes and examine them to look for the cause of the bleed. Finding the source of the bleeding may require an ultrasound scan of your eye. Ultrasound can detect many causes of vitreous haemorrhage, including posterior vitreous detachment, retinal tears and detachments, tumours and foreign objects. Sometimes a fluorescein angiogram is needed. This test shows up the blood vessels in the back of the eye. This can be helpful if looking for abnormal blood vessels such as in diabetes.

Once the source of the bleeding has been identified, treatment will depend on the cause. If there is not too much blood in the vitreous and the source of bleeding can be seen then it is treated. This means laser treatment to bleeding vessels and any other abnormal vessels and repair to any tears in the retina. After this it is a matter of waiting for the blood to slowly clear. This can take several weeks.

You will be advised to avoid strenuous activity for several days at least, as this might dislodge clots and trigger new bleeding. You are also advised to sleep with the head of your bed elevated, as this allows the blood in the vitreous to settle into the bottom of the eye, out of the line of vision.

If the blood in the vitreous obscures the view and prevents treatment of the bleeding, then the entire vitreous may be removed first. This procedure is called a vitrectomy. One of the Erie Retinal Surgery physicians will perform a vitrectomy if they can’t see the back of the eye, or if the view isn’t good enough to treat the bleeding there safely. Vitrectomy is removal of the vitreous humour completely. This is done when there is so much blood in the vitreous that it is impossible to diagnose and treat the cause. Vitrectomy is also sometimes performed if the blood in the vitreous is clearing very slowly and vision remains impaired.

HOW CAN YOU PREVENT A VITREOUS HEMORRHAGE?

Prevention of vitreous hemorrhage involves preventing the underlying causes. This includes careful and regular management of diabetic eye disease (which tends to be worse in less well-controlled diabetes) and high blood pressure and avoiding smoking. The eye should always be protected from trauma during high-risk activities such as filing, grinding and hammering, using firearms and playing sports.

WHAT SHOULD YOU DO IF YOU THINK YOU HAD A VITREOUS HEMORRHAGE?

If you experience symptoms consistent with vitreous hemorrhage or have a history of eye bleeds, contact us at Erie Retinal Surgery and we will arrange for you to be evaluated. You can expect a dilated examination to look for the extend of the bleed and the underlying cause. If you have any questions, please feel free to contact us any time.