Vitreous hemorrhage


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  • 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


Clinical Features

Differential Diagnosis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis


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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
  • 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


  1. Correct coagulopathy
  2. Ophtho consult (should see ophtho within 24-48 hours)
    • Treatment directed at underlying cause
  3. Avoid NSAIDs and anticoagulants
  4. Elevate the head of the bed
  5. Treat nausea/vomiting

See Also


  1. 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