Vitreous hemorrhage: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
[[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]]'' | ''In the setting of trauma, must assess for [[Globe Rupture]]'' | ||
*Visual acuity | *Visual acuity | ||
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**INR for patients on [[warfarin]] | **INR for patients on [[warfarin]] | ||
*[[Fundoscopy]] | *[[Fundoscopy]] | ||
**May show gross hemorrhage | **May show gross hemorrhage | ||
**Blood may obscure retina | **Blood may obscure retina | ||
**Decreased red reflex | **Decreased red reflex | ||
Revision as of 01:36, 16 March 2016
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
- 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
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
Diagnosis
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
- 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