Vitreous Hemorrhage

What is a vitreous hemorrhage?

A vitreous hemorrhage is when you have bleeding inside the vitreous of your eye, causing sudden — but painless — vision loss in that eye. It can lead to permanent vision loss, depending on what’s causing it.

It could happen for many reasons, so finding the underlying cause is a top priority before treating it. It’s more likely to happen in people with diabetes-related retinopathy.

The vitreous is the largest space inside your eye. It contains the vitreous body, a gel-like substance. The vitreous body is solid enough to help your eye hold its globe-like shape.

What are the symptoms of vitreous hemorrhage?

The main symptom of vitreous hemorrhage is sudden vision deterioration or vision loss. The vitreous is supposed to be clear so light can pass through it. Blood in the vitreous blocks that light, causing the symptoms.

Vitreous hemorrhage doesn’t cause changes that others can see in your eye. When this condition happens on its own, it doesn’t cause any visible bleeding at the front of your eye. Even with the right tools, eye specialists might have trouble seeing a hemorrhage that’s smaller or off to one side.

What causes vitreous hemorrhage?

Vitreous hemorrhage happens when blood vessels in your eye leak blood into the vitreous. There are two main ways that can happen: mechanical force or an underlying disease.

Mechanical force causes

There are several ways that physical force can cause vitreous hemorrhage. They include:

• Direct injury. Blunt impacts or sharp objects can damage the blood vessels in your eye, causing bleeding into the vitreous. This is the most common cause of vitreous hemorrhage in people under 40.
• Sharp movements. An example is shaken baby syndrome, where sharp movements break blood vessels inside an infant’s eyes.
• Interior separations. If the vitreous detaches from your retina, that can strain and break the interconnecting blood vessels and cause bleeding. Posterior vitreous detachment (PVD) and retinal tears or detachments are examples of this.
• Overpressure. Too much pressure inside your head or eye, like from the Valsalva maneuver, can break blood vessels. It can also happen with sneezing and coughing incorrectly.

Underlying disease causes

Diseases that weaken blood vessels in your eye or disrupt how they should work can lead to vitreous hemorrhage. Examples include, but aren’t limited to, the following:

• Type 2 diabetes and diabetes-related retinopathy
• High blood pressure (hypertension)
• Retinal vein occlusion (blockage)
• Sickle cell disease
• Eye cancers
• Blood disorders such as anemia or hemophilia
• Conditions that damage blood vessels, like vasculitis
• Wet age-related macular degeneration

What are the complications of vitreous hemorrhage?

Vitreous hemorrhage can also sometimes cause long-term vision changes. Some of these are permanent, while others just take longer to go away. Your eye care specialist can tell you more about what’s most likely to happen in your case and what you can or should do to help yourself recover.

How is vitreous hemorrhage diagnosed?

An eye care specialist can diagnose a vitreous hemorrhage using a combination of methods. Usually, an ophthalmoscope or a slit lamp exam is all it takes to see the bleeding. Still, your provider may recommend additional tests to check for other possible bleeding causes.

What tests will be done to diagnose vitreous hemorrhage?

Several lab and imaging tests can help diagnose vitreous hemorrhage or conditions that cause them. The most likely tests include:

• Blood tests. These check your blood sugar levels and look for problems with your blood itself. Examples include anemia, clotting disruptions, blood disorders and more.
• Ultrasound. This test uses sound waves to “see” inside your eye. It’s a key way to diagnose vitreous hemorrhage when your provider can’t see far enough inside your eye.
• Optical coherence tomography. This test uses a low-power laser to visualize and make a picture of the back of your eye. It’s especially helpful for showing blood vessels inside your eye.
• Imaging scans of your brain. Computed tomography (CT) and magnetic resonance imaging (MRI) scans can see if your brain is putting too much pressure on blood vessels in your eye.

How is vitreous hemorrhage treated?

There are a few different treatment approaches, and sometimes your treatment will involve more than one of these. They include:

• Conservative treatment. This involves waiting for several days and looking for any changes. Often, your body can repair whatever led to the hemorrhage if it has time to do so. You may need to rest or avoid strenuous activity during this time.
• Focal treatments. These approaches repair damaged blood vessels inside your eye or address other issues using precisely applied extreme temperatures. Heat or cold treatments or lasers are the tools of choice for this.
• Surgery. The most common surgery, vitrectomy, removes the vitreous fluid from inside your eye and replaces it with something else. The replacement can be saline, silicone oil or a gas bubble.
• Medications. Healthcare providers often use medications that limit blood vessel growth. These can prevent new blood vessel growth (neovascularization), which can cause new blood vessels to intrude on your vision and make it harder to see.
• Treating any underlying causes or contributing factors. Treating conditions that cause or contribute to vitreous hemorrhage can help heal an existing one and prevent future hemorrhages too.

Because there are so many treatment options, your eye care specialist is the best person to tell you more about the options most likely to help you.

Can vitreous hemorrhage be prevented?

Vitreous hemorrhage usually happens in ways you can’t predict or control, so they’re impossible to prevent. But there are a few ways to reduce your risk of developing them, including:

• Wear eye protection. Protective items like safety glasses or goggles can prevent injury-related vitreous hemorrhages.
• Get regular checkups. An annual physical with a primary care provider can detect chronic conditions like Type 2 diabetes long before you have any symptoms.
• Manage chronic conditions. Managing chronic conditions — like Type 2 diabetes or high blood pressure — can reduce your odds of having a vitreous hemorrhage.
• Get regular eye exams if necessary. Regular eye exams help you stay aware of what’s happening inside your eye and act accordingly.

What can I expect if I have a vitreous hemorrhage?

If you have a vitreous hemorrhage, you can expect sudden vision loss or disruption, but it won’t hurt. The vision loss can look like a sudden appearance of floaters or a cobweb-like effect, or your vision might look hazy or cloudy.

How long vitreous hemorrhage lasts

How long a vitreous hemorrhage lasts depends on many factors. Those include what caused it, how severe it is and what treatments you received. It can take days or weeks for your vision to return to how it was before.

Blood in the vitreous can eventually settle to the bottom of your eye, but it takes time to do that. Your body can remove blood from the vitreous, but that's also a slow process.

What’s the outlook for vitreous hemorrhage?

The outlook for vitreous hemorrhage depends on what caused it and whether you got treatment quickly. Chronic conditions like Type 2 diabetes or macular degeneration tend to have worse outcomes. Your eye care specialist can tell you what's most likely for your specific case and what you can do to improve your own odds of a positive outcome.

When should I see my healthcare provider?

If you have sudden, painless vision loss, you need medical attention as soon as possible. You can’t self-diagnose or self-treat vitreous hemorrhage. You need a trained eye care specialist to diagnose it and offer treatment options.