Vitreous hemorrhage

Background

Ocular - Vitreous hemorrhage.gif
  • 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

Clinical Features

Differential Diagnosis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Evaluation

Vitreous hemorrhage.jpg
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
    • Small dots or mobile lines may represent early, mild hemorrhage
    • Look for retinal injury/tears
      • require operative intervention

Management

  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

References