Vitreous Hemorrhage
Encyclopedia
Vitreous Hemorrhage is the extravasation
of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens
and the retina
of the eye
. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
. Abnormal blood vessels can form in the back of the eye of a person with diabetes. These new blood vessels are weaker and prone to breaking and causing hemorrhage. Diabetic retinopathy accounts for 31.5-54% of all cases of vitreous hemorrhage in adults in the United States.
is the leading cause of vitreous hemorrhage in young people, and accounts for 12-18.8% of cases in adults.
can allow fluids from the eye to leak in behind the retina, which causes retinal detatchment. When this occurs, blood from the retinal blood vessels can bleed into the vitreous. Retinal tear accounts for 11.4-44% of vitreous hemorrhage cases.
Symptoms/Diagnosis=
Common symptoms of vitreous hemorrhage include:
Small vitreous hemorrhage often manifests itself as "floaters". A moderate case will often result in dark streaks in the vision, while dense vitreous hemorrhage can significantly inhibit vision.
Vitreous hemorrhage is diagnosed by identifying symptoms, examining the eye, and performing tests to identify cause. Some common tests include:
Treatments=
The treatment method used depends on the cause of the hemorrhage. In most cases, the patient is advised to rest with their head elevated 30-45°, and sometimes to put patches over the eyes to limit movement prior to treatment in order to allow the blood to settle. The patient is also advised to avoid taking medications that cause blood thinning (such as aspirin or similar medications).
The goal of the treatment is to fix the cause of the hemorrhage as quickly as possible. Retinal tears are closed by Laser treatment
or cryotherapy
, and detached retinas are reattached surgically.
Even after treatment, it can take months for the body to clear all of the blood from the vitreous. In cases of vitreous hemorrhage due to detached retina, long standing vitreous hemorrhage with a duration of more than 2–3 months, or cases associated with rubeosis iridis
or glaucoma
, a vitrectomy
may be necessary to remove the standing blood in the vitreous.
Extravasation
Extravasation is the accidental administration of intravenously infused medicinal drugs into the surrounding tissue, either by leakage , or direct exposure...
of blood into the areas in and around the vitreous humor of the eye. The vitreous humor is the clear gel that fills the space between the lens
Lens
-Optics:*Lens , an optical element which converges or diverges light**Lens , a part of the eye**Corrective lens for correction of human vision***Contact lens, placed on the cornea of the eye**Photographic lens, a lens designed for use on a camera...
and the retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
of the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
. A variety of conditions can result in blood leaking into the vitreous humor, which can cause impaired vision, floaters, and photopsia.
Diabetic Retinopathy
The most common cause found in adults is diabetic retinopathyDiabetic retinopathy
Diabetic retinopathy is retinopathy caused by complications of diabetes mellitus, which can eventually lead to blindness....
. Abnormal blood vessels can form in the back of the eye of a person with diabetes. These new blood vessels are weaker and prone to breaking and causing hemorrhage. Diabetic retinopathy accounts for 31.5-54% of all cases of vitreous hemorrhage in adults in the United States.
Trauma
Some injuries can cause blood vessels in the back of the eye to bleed. TraumaTrauma
Trauma can refer to:-In psychology and medicine:* Trauma , an often serious and body-altering physical injury, such as the removal of a limb...
is the leading cause of vitreous hemorrhage in young people, and accounts for 12-18.8% of cases in adults.
Retinal Tear/Detachment
A tear in the retinaRetina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
can allow fluids from the eye to leak in behind the retina, which causes retinal detatchment. When this occurs, blood from the retinal blood vessels can bleed into the vitreous. Retinal tear accounts for 11.4-44% of vitreous hemorrhage cases.
Posterior Vitreous Detachment
As one gets older, pockets of fluid can develop in the vitreous. When these pockets develop near the back of the eye, the vitreous can pull away from the retina and possibly tear it. Posterior vitreous detachment accounts for 3.7-11.7% of vitreous hemorrhage cases.Other Causes
Less common causes of vitreous hemorrhage make up 6.4-18% of cases, and include:- Proliferative sickle cell retinopathy
- Macroaneurysm
- Age-related macular degenerationMacular degenerationAge-related macular degeneration is a medical condition which usually affects older adults and results in a loss of vision in the center of the visual field because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness and visual impairment in older adults...
- Terson syndromeTerson syndromeTerson syndrome or Terson's syndrome is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. Vitreous hemorrhage of the eye can also occur in association with intracranial hemorrhage and elevated intracranial pressure . Intraocular hemorrhage can be...
- Retinal neovascularizationNeovascularizationNeovascularization is the formation of functional microvascular networks with red blood cell perfusion. Neovascularization differs from angiogenesis in that angiogenesis is mainly characterized by the protrusion and outgrowth of capillary buds and sprouts from pre-existing blood vessels.In...
as a result of branch or central retinal vein occlusion - other— about 7 cases in 100,000 have no known cause attributed to them.
Symptoms/Diagnosis=
Common symptoms of vitreous hemorrhage include:
- Blurry vision
- Floaters- faint cobweb-like apparitions floating through the field of vision
- Reddish tint to vision
- PhotopsiaPhotopsiaPhotopsia is the presence of perceived flashes of light. It is most commonly associated with posterior vitreous detachment, migraine with aura, migraine aura without headache, retinal break or detachment, occipital lobe infarction and sensory deprivation...
-brief flashes of light in the peripheral vision
Small vitreous hemorrhage often manifests itself as "floaters". A moderate case will often result in dark streaks in the vision, while dense vitreous hemorrhage can significantly inhibit vision.
Vitreous hemorrhage is diagnosed by identifying symptoms, examining the eye, and performing tests to identify cause. Some common tests include:
- Examination of the eye with a microscope
- Pupil dialationMydriasisMydriasis is a dilation of the pupil due to disease, trauma or the use of drugs. Normally, the pupil dilates in the dark and constricts in the light to respectively improve vividity at night and to protect the retina from sunlight damage during the day...
and examination - An ultrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
examination may be used if the doctor does not have a clear view of the back of the eye - Blood tests to check for specific causes such as diabetes
- A CT scan to check for injury around the eye
- referral to a retinal specialist
Treatments=
The treatment method used depends on the cause of the hemorrhage. In most cases, the patient is advised to rest with their head elevated 30-45°, and sometimes to put patches over the eyes to limit movement prior to treatment in order to allow the blood to settle. The patient is also advised to avoid taking medications that cause blood thinning (such as aspirin or similar medications).
The goal of the treatment is to fix the cause of the hemorrhage as quickly as possible. Retinal tears are closed by Laser treatment
Refractive surgery
Refractive eye surgery is any eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea or cataract surgery. The most common methods today use excimer lasers to...
or cryotherapy
Cryotherapy
Cryotherapy is the local or general use of low temperatures in medical therapy or the removal of heat from a body part. The term "cryotherapy" comes from the Greek cryo meaning cold and the word therapy meaning cure...
, and detached retinas are reattached surgically.
Even after treatment, it can take months for the body to clear all of the blood from the vitreous. In cases of vitreous hemorrhage due to detached retina, long standing vitreous hemorrhage with a duration of more than 2–3 months, or cases associated with rubeosis iridis
Rubeosis iridis
Rubeosis iridis is a medical condition of the iris of the eye in which new abnormal blood vessels are found on the surface of the iris.-Pathophysiology:...
or glaucoma
Glaucoma
Glaucoma is an eye disorder in which the optic nerve suffers damage, permanently damaging vision in the affected eye and progressing to complete blindness if untreated. It is often, but not always, associated with increased pressure of the fluid in the eye...
, a vitrectomy
Vitrectomy
Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye. Anterior vitrectomy entails removing small portions of the vitreous from the front structures of the eye—often because these are tangled in an intraocular lens or other structures...
may be necessary to remove the standing blood in the vitreous.