Description, Causes and Risk Factors:
The vitreous is the clear jelly-like substance that fills the eye. When bleeding into the vitreous occurs, it is called a vitreous hemorrhage. Bleeding can occur as a result of a ruptured microaneurysm in diabetics, leakage from abnormal vessels in retinal vascular conditions, or from damage to the retina.
Microaneurysm usually occurs in patients who have diabetic retinopathy (DR). When the blood sugar is high, the blood vessels get damaged, causing localized weak areas. Over time, these weak areas start to protrude out, forming a microaneurysm. When an aneurism bursts, blood enters into the vitreous, causing a vitreous hemorrhage.
Abnormal vessels that grow in response to low oxygen levels in retinal vascular conditions (proliferative diabetic retinopathy, vein occlusions, etc) are very fragile and tend to leak. Sometimes these abnormal vessels grow from the retina into the vitreous cavity and leak blood, causing a vitreous hemorrhage.
Mechanical damage to the blood vessels of the retina can occur from a retinal tear or trauma to the eye. Like any other part of the body, if a blood vessel gets damaged, it will start to bleed. If mechanical damage occurs to the retina, retinal blood vessels can get damaged and bleed into the vitreous cavity, causing a vitreous hemorrhage.
A vitreous hemorrhage can occur in anyone, though the incidence of occurrence is relatively small with only 7 cases per 100,000 people in the US.
Proliferative diabetic retinopathy.
Retinal vein occlusion with proliferative retinopathy.
Posterior vitreous detachment without a tear.
Trauma to the eye.
Symptoms of a vitreous hemorrhage include:
Loss of vision.
Seeing grey patches
Seeing flashing lights
Increased sensitivity to bright light.
The evaluation of a vitreous hemorrhage begins with a medical history and physical exam. A slit lamp examination is necessary to completely evaluate an injured eye.
Tests that may be used to evaluate vitreous hemorrhage include:
CT scanning of the orbit.
MRI scan of the orbits.
Ultrasound of the eye (B-scan) uses sound waves that reflect off the different tissues in the eye to form an image. These images can determine the amount of blood in the eye and evaluate the retina when the view inside is obstructed.
Optical Coherence Tomography (OCT) is a high definition image of the retina taken by a scanning ophthalmoscope with a resolution of 5 microns. These scans are used to determine the extent of the vitreous hemorrhage and if there has been any leakage of blood into or under the retina in addition to the vitreous hemorrhage. The doctor will use OCT images to objectively document the progress of the disease throughout the course of your treatment.
Initial treatment may be observation alone. Minor hemorrhages often clot and resolve on their own over time. Unfortunately, it may take months for full visual recovery from a vitreous hemorrhage. Current research has produced drugs that can dissolve the vitreous gel inside the eye and may dramatically reduce the recovery time. These drugs are currently in the investigational stage and are awaiting FDA approval.
For more severe and debilitating vitreous hemorrhage, a vitrectomy may be performed. A vitrectomy is a surgical procedure that removes the vitreous gel and the blood from inside the eye. After the vitreous is removed, the surgeon will refill the eye with a special saline solution that closely resembles the natural vitreous fluid in the eye. Recovery from the procedure will take up to 6 weeks and complete vision recovery will take a little longer.
General treatment options:
Limited physical activity.
Avoid anticoagulants and other medications that promote bleeding.
Eye shield for vitreous hemorrhage.
Bed rest: With the head of the bed elevated or sitting upright.
Freezing is used to repair the retina.
In some cases, surgery is performed to remove blood from within the eye.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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