Vitreous hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
*Vitreous is avascular substance that helps keep retina in place | *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 (a/w DM) can result in weak vessels w/ high propensity for bleeding | **Neovascularization (a/w DM) can result in weak vessels w/ 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== | ==Diagnosis== | ||
*Fundoscopy | |||
**May show gross hemorrhage | |||
**Blood may obscure retina | |||
*Ultrasound | |||
**Use linear probe (7.5-10-MHz) | |||
**Bright echoes in posterior chamber | |||
**Small dots or mobile lines may represent early, mild hemorrhage | |||
==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== | ==Treatment== | ||
#Correct coagulopathy | #Correct coagulopathy | ||
#Ophtho consult | #Ophtho consult | ||
##Directed at underlying cause | |||
#Avoid NSAIDs and anticoagulants | |||
==Source== | ==Source== | ||
Tintinalli | Tintinalli | ||
UpToDate | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 19:53, 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
- Ultrasound
- Use linear probe (7.5-10-MHz)
- Bright echoes in posterior chamber
- Small dots or mobile lines may represent early, mild hemorrhage
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
Treatment
- Correct coagulopathy
- Ophtho consult
- Directed at underlying cause
- Avoid NSAIDs and anticoagulants
Source
Tintinalli UpToDate