Retinal Hemorrhage

What is a retinal hemorrhage?

A retinal hemorrhage is the medical term for bleeding in your retina. Hemorrhages are any type of bleeding from a damaged blood vessel. Retinal hemorrhages can be caused by traumas (like getting hit in the head) and health conditions that affect your eyes or blood vessels.

Most people have a retinal hemorrhage in only one eye at a time (a unilateral retinal hemorrhage). It’s less common, but it’s also possible to develop retinal hemorrhages in both eyes at the same time (bilateral retinal hemorrhage).

Some people never know they have a retinal hemorrhage and don’t experience any symptoms. Others lose vision. The damage can be permanent depending on what causes a retinal hemorrhage in your eye and how much bleeding there is.

How healthcare providers treat a retinal hemorrhage depends on its cause. Many retinal hemorrhages don’t need treatment. You’ll need injections, laser treatment or surgery if you have a retinal hemorrhage that affects your vision or that could cause permanent blindness.

Visit your eye care specialist as soon as you notice any changes in your eyes or vision. Go to the emergency room (ER) if you suddenly lose the ability to see in one or both eyes.

What are the types of retinal hemorrhages?

Your eye care specialist will classify a retinal hemorrhage based on where it develops on your retina. Additionally, they might refer to the hemorrhage based on its shape or what it looks like. A retinal hemorrhage can also be multilayered — a retinal hemorrhage that affects more than one part of your retina.

The most common types of retinal hemorrhages include:

• Intraretinal hemorrhages: Intraretinal hemorrhages are tears or breaks in the tissue of your retina itself. They’re sometimes called dot-and-blot hemorrhages.
• Retinal nerve fiber layer hemorrhages: The retinal nerve fiber layer (RNFL) is the group of nerve cells that connect your retina to your optic nerve. Flame hemorrhages, disc or Drance hemorrhages and splinter hemorrhages all affect the RNFL.
• Preretinal hemorrhages: Preretinal hemorrhages are tears in the membrane that separates your vitreous cavity from your retina. They’re sometimes referred to as boat-shaped or D-shaped hemorrhages.
• Vitreous hemorrhages: Your eyeballs are filled with vitreous gel — a gel made of water and collagen. Vitreous hemorrhages happen when your retina bleeds into the vitreous cavity in your eye.

Who gets retinal hemorrhages?

Anyone can experience a retinal hemorrhage. People with certain health conditions are more likely to develop one, including:

• High cholesterol (hyperlipidemia).
• High blood pressure (hypertension).
• Atherosclerosis.
• Diabetes.
• Macular degeneration.

People who take blood thinners like (aspirin or warfarin) have a higher risk of retinal hemorrhages.

Babies are sometimes born with a retinal hemorrhage. Around half of babies born via assisted delivery (like vacuum extraction and forceps delivery) have a retinal hemorrhage at birth.

It’s more common for adults older than 40 to experience a retinal hemorrhage as they develop common age-related eye problems.

What are the symptoms of a retinal hemorrhage?

Many people don’t experience any symptoms when they have a retinal hemorrhage.

If you do have symptoms, you’ll probably notice changes in your vision. The most common retinal hemorrhage symptoms include:

• Sudden vision loss.
• Your vision getting noticeably worse or blurry.
• Blind spots.
• Patches or spots of darkness in your vision.
• Seeing flashes or floaters.

What causes retinal hemorrhages?

Trauma or health conditions that damage your eyes or blood vessels over time cause retinal hemorrhages. The most common causes of retinal hemorrhages include:

• Trauma.
• Vascular disease (conditions that affect your blood vessels).
• Autoimmune disorders.

Leukemia and infections like bacterial endocarditis can also cause retinal hemorrhages. People older than 40 are more likely to develop age-related eye conditions like macular degeneration that can cause retinal hemorrhages.

Even if you have a condition that can lead to a retinal hemorrhage, it doesn’t mean you’ll definitely develop one. Similarly, it’s possible to experience a retinal hemorrhage without knowing you have one of these conditions.

See your healthcare provider for regular checkups to help catch warning signs of a condition or issue that might cause a retinal hemorrhage in the future.

Visit your eye care specialist as soon as you notice any changes in your eyes or vision.

Trauma

Trauma that causes retinal hemorrhages includes:

• Eye injuries: Any injury that damages your head or eyes can damage the blood vessels in your retinas.
• Shaken baby syndrome: Shaking an infant or toddler can cause bleeding in their brain and retinas.
• Altitude sickness: Moving to a higher elevation too fast can change the pressure in your eyes fast enough to cause a retinal hemorrhage. This can also happen if you’re a scuba diver who ascends from deep water too quickly.
• Carbon monoxide poisoning: Carbon monoxide (CO) poisoning happens when you breathe in fumes that contain CO. You can get very sick or even die if you breathe high levels of CO for even a few minutes.

Vascular disease

Conditions that damage or restrict your blood vessels can lead to a retinal hemorrhage. These conditions can be dangerous because they don’t usually cause symptoms until they’ve already damaged your blood vessels enough to cause complications. The most common types of vascular disease that cause retinal hemorrhages include:

• Hypertension (high blood pressure).
• High cholesterol.
• Retinal vein occlusions (RVOs).
• Postpartum preeclampsia.
• Anemia.

Autoimmune disorder

Autoimmune disorders happen when your immune system accidentally attacks your body instead of protecting it. It’s unclear why your immune system does this. Some types of autoimmune disorders can damage your retinas and cause retinal hemorrhages, including:

• Diabetes.
• Lupus.
• Vasculitis.

How are retinal hemorrhages diagnosed?

Your eye care specialist will diagnose a retinal hemorrhage with an eye exam. They’ll look at your eyes (including inside them) and perform a visual acuity test.

You might also need a few tests to diagnose what caused the retinal hemorrhage or to help your eye care specialist see how damaged your retina is. The most common tests you’ll need include:

• A blood test to check for signs of infections or to check your cholesterol.
• Angiography.
• Magnetic resonance imaging (MRI).

How are retinal hemorrhages treated?

How a retinal hemorrhage is treated depends on a few factors:

• What caused it.
• How much your vision is affected.
• How severe the bleeding in your retina is.

Many people don’t need treatment. If you have a small retinal hemorrhage that isn’t getting worse and isn’t affecting your ability to see, you’ll probably only need a few follow-up eye exams to make sure the hemorrhage is healing on its own. Your eye care specialist will tell you how often you’ll need your eyes checked.

If you do need treatment, you might need one of the following procedures:

• Laser or cryotherapy to repair the retinal hemorrhage.
• Surgery to normalize pressure in your eye or reattach your retina.
• An injection of medication like anti-vascular endothelial growth factor (anti-VEGF) or a corticosteroid to reduce inflammation inside your eye.

How long does it take to recover from a retinal hemorrhage?

Your eye care specialist will tell you how long it’ll take to recover based on your specific symptoms and what caused the hemorrhage in your eye. Most people need a few weeks to recover from surgery to repair a retinal hemorrhage.

You’ll probably need to avoid medications like over-the-counter (OTC) NSAIDs (and any other anticoagulant medication that thins your blood) while you’re recovering. Talk to your ophthalmologist about what to expect.

How can I prevent a retinal hemorrhage?

The best way to prevent a retinal hemorrhage is to prevent conditions that cause them. Some steps you can take include:

• Eating a healthy diet low in saturated and trans fats, cholesterol, sodium (salt) and sugar.
• Exercising regularly.
• Maintaining a weight that’s healthy for you.
• Managing any health conditions, especially diabetes, high blood pressure and high cholesterol.
• Quitting smoking.
• Visiting a healthcare provider and eye care specialist regularly.

When should I have my eyes examined?

Having your eyes and vision checked regularly can help your eye care specialist identify problems right away. How often you should get your eyes checked usually depends on your age:

• Adults under 40: Every five to 10 years.
• Adults between 40 and 54: Every two to four years.
• Adults older than 55: Every one to three years.

You might need your eyes checked more often than this if you wear glasses, contacts or need another type of visual aid. People with diabetes need their eyes checked more often than what’s listed here.

Ask your eye care specialist how often you need an eye exam.

What can I expect if I have a retinal hemorrhage?

Many people make a full recovery from a retinal hemorrhage, even if they need surgery.

It’s possible for a retinal hemorrhage to cause permanent damage to your retina that affects your ability to see for the rest of your life. You might also have low vision after a retinal hemorrhage.

When should I see my healthcare provider?

See your healthcare provider or eye care specialist as soon as you notice any changes in your eyes or vision.

Go to the emergency room (ER) if you have any of the following symptoms:

• A sudden loss of vision.
• Severe eye pain.
• You see new flashes or floaters in your eyes.

What questions should I ask my doctor?

• What caused the retinal hemorrhage?
• Which type of retinal hemorrhage do I have?
• Will I need surgery?
• Will this affect my vision forever?

What is a retinal hemorrhage vs. a retinal detachment?

Retinal hemorrhages and retinal detachment are both serious issues that affect your retina.

A retinal hemorrhage is any injury or damage to your eye that makes blood vessels in your retina break or bleed. They can be caused by lots of other conditions and can happen suddenly (during trauma) or over time from a condition like vascular disease.

Retinal detachment (a detached retina) happens when your retina pulls away from the tissue at the back of your eye that supports it. It can cause a retinal hemorrhage. A detached retina usually isn’t painful. You’ll notice changes in your vision like bright flashes of light, darkened peripheral vision or a sudden loss of sight in one eye. Trauma and conditions that cause fluid buildup in your eye, like uveitis, can cause retinal detachment.

Go to the emergency room if you lose vision in one or both of your eyes or if you see new eye flashes and floaters.

What is a retinal hemorrhage vs. a subconjunctival hemorrhage?

Retinal hemorrhages and subconjunctival hemorrhages are both bleeding in your eye. The difference is where the hemorrhage is.

Retinal hemorrhages affect the retina — the layer of cells at the back of your eye.

A subconjunctival hemorrhage is a broken blood vessel on the surface of your eye. The conjunctiva is a thin, clear membrane that protects your eye.

A note from Cleveland Clinic

Retinal hemorrhages are caused when something damages or breaks the blood vessels in your retina. They can be temporary issues that heal on their own. They might also cause permanent damage to your eye that affects your ability to see. Talk to your healthcare provider or eye care specialist if you have a health condition that can cause retinal hemorrhages. They’ll help you understand what you can do to reduce your risk.