Vitreous hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
*Vitreous is avascular substance that helps keep retina in place | [[File:Ocular - Vitreous hemorrhage.gif|thumb]] | ||
*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 | **Traction at its attachments at the ora serrata and optic disc can result in bleeding | ||
**Neovascularization ( | **Neovascularization (associated with [[DM]]) can result in weak vessels with high propensity for bleeding | ||
*May cause permanent blindness | |||
==Causes== | ===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== | ==Clinical Features== | ||
*Sudden, painless [[vision loss]] | |||
*[[Acute Onset Flashers and Floaters]] | |||
*Generalized unilateral hazy vision | |||
==Diagnosis== | ==Differential Diagnosis== | ||
{{Acute vision loss noninflamed DDX}} | |||
== | ==Evaluation== | ||
[[File:Vitreous hemorrhage.jpg|thumb]] | |||
[[File:Vit_Hem_us.jpg|thumb|Vitreous Hemorrhage on ultrasound]] | |||
''In the setting of trauma, must assess for [[Globe Rupture]]'' | |||
*Visual acuity | |||
**Degree of vision loss proportional to size of hemorrhage | |||
*Assess for [[coagulopathy]] | |||
**INR for patients on [[warfarin]] | |||
*[[Fundoscopy]] | |||
**May show gross hemorrhage | |||
**Blood may obscure retina | |||
**Decreased red reflex | |||
*[[Ocular ultrasound|Ultrasound]] | |||
**Bright echoes in posterior chamber | |||
**Moving the eye can cause swirling of hemorrhage known as "washing machine sign"<ref>Stringer CEA, Ahn JS, Kim DJ. Asteroid Hyalosis: A Mimic of Vitreous Hemorrhage on Point of Care Ultrasound. CJEM. 2017;19(4):317-320. doi:10.1017/cem.2016.358</ref> | |||
**Small dots or mobile lines may represent early, mild hemorrhage | |||
**Look for retinal injury/tears | |||
***require operative intervention | |||
==Management== | |||
#Correct coagulopathy | #Correct coagulopathy | ||
#Ophtho consult | #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]] | |||
== | ==See Also== | ||
*[[Acute vision loss (noninflamed)]] | |||
*[[Ocular ultrasound]] | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Ophthalmology]] | |||
Latest revision as of 08:30, 15 January 2021
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 (associated with DM) can result in weak vessels with high propensity for bleeding
- May cause permanent blindness
Causes
- Diabetic retinopathy
- Trauma
- 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
Differential Diagnosis
Acute Vision Loss (Noninflamed)
- Painful
- Arteritic anterior ischemic optic neuropathy
- Optic neuritis
- Temporal arteritis†
- Painless
- Amaurosis fugax
- Central retinal artery occlusion (CRAO)†
- Central retinal vein occlusion (CRVO)†
- High altitude retinopathy
- Open-angle glaucoma
- Posterior reversible encephalopathy syndrome (PRES)
- Retinal detachment†
- Stroke†
- Vitreous hemorrhage
- Traumatic optic neuropathy (although may have pain from the trauma)
†Emergent Diagnosis
Evaluation
In the setting of trauma, must assess for Globe Rupture
- Visual acuity
- Degree of vision loss proportional to size of hemorrhage
- Assess for coagulopathy
- INR for patients on warfarin
- Fundoscopy
- May show gross hemorrhage
- Blood may obscure retina
- Decreased red reflex
- Ultrasound
- Bright echoes in posterior chamber
- Moving the eye can cause swirling of hemorrhage known as "washing machine sign"[1]
- Small dots or mobile lines may represent early, mild hemorrhage
- Look for retinal injury/tears
- require operative intervention
Management
- 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
See Also
References
- ↑ Stringer CEA, Ahn JS, Kim DJ. Asteroid Hyalosis: A Mimic of Vitreous Hemorrhage on Point of Care Ultrasound. CJEM. 2017;19(4):317-320. doi:10.1017/cem.2016.358