Vitreous hemorrhage: Difference between revisions
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===Causes=== | ===Causes=== | ||
*Diabetic retinopathy | *Diabetic retinopathy | ||
*Trauma | *[[Trauma]] | ||
**Shaken baby syndrome | **[[Shaken baby syndrome]] | ||
*[[Sickle cell disease]] | *[[Sickle cell disease]] | ||
*Posterior vitreous detachment | *[[Posterior vitreous detachment]] | ||
**Elderly | **Elderly | ||
*Retinal tear | *Retinal tear | ||
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==Clinical Features== | ==Clinical Features== | ||
*Sudden, painless vision loss | *Sudden, painless [[vision loss]] | ||
*[[Acute Onset Flashers and Floaters]] | *[[Acute Onset Flashers and Floaters]] | ||
*Generalized unilateral hazy vision | *Generalized unilateral hazy vision | ||
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{{Acute vision loss noninflamed DDX}} | {{Acute vision loss noninflamed DDX}} | ||
== | ==Evaluation== | ||
[[File:Vitreous hemorrhage.jpg|thumb]] | [[File:Vitreous hemorrhage.jpg|thumb]] | ||
[[File:Vit_Hem_us.jpg|thumb|Vitreous Hemorrhage on ultrasound]] | [[File:Vit_Hem_us.jpg|thumb|Vitreous Hemorrhage on ultrasound]] | ||
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**Blood may obscure retina | **Blood may obscure retina | ||
**Decreased red reflex | **Decreased red reflex | ||
*[[ | *[[Ocular ultrasound|Ultrasound]] | ||
**Bright echoes in posterior chamber | **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 | **Small dots or mobile lines may represent early, mild hemorrhage | ||
**Look for retinal injury/tears | **Look for retinal injury/tears | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Ophthalmology]] | [[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