Vitreous hemorrhage: Difference between revisions
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*[[Acute Onset Flashers and Floaters]] | *[[Acute Onset Flashers and Floaters]] | ||
*Generalized unilateral hazy vision | *Generalized unilateral hazy vision | ||
==Differential Diagnosis== | |||
{{Acute vision loss noninflamed DDX}} | |||
==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 | *Fundoscopy | ||
**May show gross hemorrhage [[File:Vit_Hem_us.jpg|thumb|Vitreous Hemorrhage on ultrasound]] | **May show gross hemorrhage [[File:Vit_Hem_us.jpg|thumb|Vitreous Hemorrhage on ultrasound]] | ||
Line 32: | Line 40: | ||
***require operative intervention | ***require operative intervention | ||
== | ==Management== | ||
#Correct coagulopathy | #Correct coagulopathy | ||
#Ophtho consult (should see ophtho within 24-48 hours) | #Ophtho consult (should see ophtho within 24-48 hours) | ||
# | #*Treatment directed at underlying cause | ||
#Avoid NSAIDs and anticoagulants | #Avoid [[NSAIDs]] and anticoagulants | ||
#Elevate the head of the bed | #Elevate the head of the bed | ||
#Treat nausea/vomiting | #Treat [[nausea/vomiting]] | ||
== | ==References== | ||
[[Category:Ophtho]] | [[Category:Ophtho]] |
Revision as of 01:32, 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 (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
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