Vitreous hemorrhage: Difference between revisions
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**May show gross hemorrhage | **May show gross hemorrhage | ||
**Blood may obscure retina | **Blood may obscure retina | ||
**Decreased red reflex | |||
*Ultrasound | *Ultrasound | ||
**Use linear probe (7.5-10-MHz) | **Use linear probe (7.5-10-MHz) | ||
**Bright echoes in posterior chamber | **Bright echoes in posterior chamber | ||
**Small dots or mobile lines may represent early, mild hemorrhage | **Small dots or mobile lines may represent early, mild hemorrhage | ||
**Look for retinal injury/tears | |||
***require operative intervention | |||
==Work-Up== | ==Work-Up== | ||
| Line 48: | Line 51: | ||
##Treatment directed at underlying cause | ##Treatment directed at underlying cause | ||
#Avoid NSAIDs and anticoagulants | #Avoid NSAIDs and anticoagulants | ||
#Elevate the head of the bed | |||
#Treat nausea/vomiting | |||
==Source== | ==Source== | ||
Tintinalli | Tintinalli | ||
UpToDate | UpToDate | ||
Rosen's | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 20:15, 12 September 2013
Background
- Bleeding into the vitreous humor of the eye
- Vitreous is avascular substance that helps keep retina in place
- Traction at its attachments at the ora serrata and optic disc can result in bleeding
- Neovascularization (a/w DM) can result in weak vessels w/ high propensity for bleeding
- May cause permanent blindness
Causes
- Diabetic retinopathy
- Trauma
- Shaken baby syndrome
- Sickle cell disease
- Posterior vitreous detachment
- Elderly
- Retinal tear
- Terson Syndrome (Association with Subarachnoid Hemorrhage (SAH))
Clinical Features
- Sudden, painless vision loss
- Acute Onset Flashers and Floaters
- Generalized unilateral hazy vision
Diagnosis
- Fundoscopy
- May show gross hemorrhage
- Blood may obscure retina
- Decreased red reflex
- Ultrasound
- Use linear probe (7.5-10-MHz)
- Bright echoes in posterior chamber
- Small dots or mobile lines may represent early, mild hemorrhage
- Look for retinal injury/tears
- require operative intervention
Work-Up
- Visual acuity
- Degree of vision loss proportional to size of hemorrhage
- Assess for coagulopathy.
- INR for patients on warfarin
- In the setting of trauma, must assess for Globe Rupture
DDx
- Retinal Detachment
- Central Retinal Vein Occlusion
- Uveitis
- Acute Onset Flashers and Floaters
Treatment
- Correct coagulopathy
- Ophtho consult (should see ophtho within 24-48 hours)
- Treatment directed at underlying cause
- Avoid NSAIDs and anticoagulants
- Elevate the head of the bed
- Treat nausea/vomiting
Source
Tintinalli UpToDate Rosen's