Vitreous hemorrhage is bleeding within cavity of the eyeball. Cavity of eyeball is filled with transparent jelly like structure called Vitreous. This vitreous allows light to pass through cavity of eyeball so that it can fall on Retina, where image forms. Most of this humor consists of water, as well as a lower amount of collagen, salt, and sugar. Very high content of water keeps it transparent. So Vitreous hemorrhage is condition where vision gets affected due to bleeding in this transparent jelly. Vision affection may vary from slight blurring of vision to complete loss of vision depending upon amount of bleeding. This kind of bleeding inside the eye is not associated with other types of bleeding associated with the eye such as hyphema or sub-conjunctival hemorrhage other than in trauma cases.

1) Proliferative diabetic retinopathy

2) Retinal vascular occlusions

3) Retinal tear

4) Trauma

Vitreous hemorrhage can also occur in Wet macular degenration, Retinal artery macro aneurysm, secondary to subarachnoid hemorrhage (Terson's syndrome) and various vasculopathies causing neovascularisation. Other rare cases include blood dyscrasias, Valsalva retinopathy and intraocular tumors. 

SYMPTOMS ASSOCIATED:

 1) Sudden appearance of floaters - small vitreous hemorrhage

 2) Sudden painless loss of vision- large vitreous hemorrhage

FATE OF VITEROUS HEMORRHAGE

• Many cases of Vitreous hemorrhage will have Complete resolution of bleeding, which may occur within 4-6 weeks. This is because of tendency of intraocular structures (Trabecular meshwork) to absorb it.  This will only happen if primary bleeding has stopped and recurrent bleeding is not happening.
• Cases where bleeding keeps on happening, spontaneous resolution will not happen and vision remains grossly reduced. If such bleeding is left for long duration then there are chances of complications because of prolonged Vitreous hemorrhage.

 

COMPLICATIONS: 

Vitreous liquefaction, Degeneration: if Vitreous hemorrhage is left alone it undergoes spontaneous resolution in almost 60% cases, which is the best outcome without any intervention. But this is associated with liquification of vitreous jelly.

Ghost cell glaucoma: While undergoing spontaneous resolution, bleeding breaks into fine components which clogs the drainage system of eye leading to increase in intraocular pressure called Ghost cell Glaucoma.

Tractional retinal detachment:  If vitreous hemorrhage is dense and left alone, resolution is also associated with surface contraction in vitreous and retina. This can lead to tractional retinal detachment.

 

INVESTIGATIONS:

B scan : Is the investigation of choice if vitreous hemorrhage is quite dense and prevents you from retinal view. It shows us the Retina status, Giant retinal tears if present and status of vitreous jelly.

FFA : Retinal angiography is useful in cases of Proliferative Diabetic Retinopathy and all other vascular causes of hemorrhage.

TREATMENT:

1) Wait and watch: All fresh cases of vitreous hemorrhage can be watched with frequent evaluation provided Retina is attached beneath hemorrhage and there is no peripheral retinal tear as cause of hemorrhage. Second thing to be kept in mind is Intraocular Pressure (IOP), if IOP is under control then hemorrhage can be watched as almost 60% cases will have a short recovery time and resolve spontaneously.

2) Laser: Cases where Vitreous hemorrhage is due to Retinal tear, Diabetic Retinopathy, Retinal Vasculitis or Retinal vascular occlusion, needs to be treated with Argon laser for faster resolution. This can be done by any eye doctor trained as retina specialist.

3) Surgery: Surgery is indicated in cases where underlying retina is detached or having a traction, if IOP is increased and not medically controlled or if its recurrent with no resolution even after watch of 6 weeks. Surgery involves clearing of Vitreous hemorrhage followed by subsequent treatment of underlying pathology. This should be performed by retina eye doctor only.