Definition

Vitreous hemorrhage is bleeding within the eyeball, typically painless but can lead to significant vision loss. The incidence of vitreous hemorrhage varies with the underlying cause but can also occur spontaneously, with an estimated occurrence rate of 7 per 100,000 population.

Causes

The vitreous is a gel-like substance in the eyeball, composed of 99% water with the remainder being collagen and hyaluronic acid. It plays a crucial role in maintaining the eyeball's shape, damping vibrations from impacts, and ensuring the retinal layer stays attached to the back of the eye. The vitreous is clear, allowing light to pass through it into the eyeball. Adjacent to the vitreous are blood vessels that supply blood to the retina. Vitreous hemorrhage occurs when these blood vessels rupture due to significant trauma or structural issues.

Vitreous hemorrhage can result from specific conditions or occur spontaneously. The most prevalent cause is proliferative diabetic retinopathy, a severe retinal damage condition due to diabetes. Damaged surrounding blood vessels lead the body to form new vessels to ensure adequate retinal nutrition and oxygen. However, these new vessels can extend into the vitreous and are prone to rupturing. Other causes of vitreous hemorrhage include retinal tears and eye injuries.

Additional causes include ruptured aneurysms (blood vessels' abnormal dilation and thinning) and neovascularization due to conditions like macular degeneration (optic nerve function decline).

Risk Factor

Uncontrolled diabetes is a significant risk factor for vitreous hemorrhage. In individuals under 40 years old, vitreous hemorrhage commonly results from eye injuries. For those over 40 without diabetes, retinal tears are a frequent cause. Hematologic diseases such as leukemia and thrombocytopenia can also accelerate vitreous hemorrhage. Spontaneous vitreous hemorrhage can arise from blood vessel damage in the eye due to heart disease, diabetes, blood-thinning medications, intense coughing, or heavy lifting.

Symptoms

The primary symptom of vitreous hemorrhage is a sudden loss of vision in one eye, often accompanied by the perception of "floating objects," foggy vision, or vision obstructed by spider web-like patterns. This condition generally does not cause pain.

Diagnosis

Vitreous hemorrhage can be detected using funduscopy, which reveals blood floating in the vitreous chamber, obstructing the overall retinal view. The condition's impact on eye functions. Visual acuity and light reflexes should be assessed. Visual acuity typically diminishes due to blood obstructing light entry into the eye. If an injury is suspected, a slit lamp examination can identify anterior eye bleeding. Blood pressure measurements are also pertinent as elevated blood pressure can cause eye vessel rupture.

Laboratory and imaging tests help identify the hemorrhage's cause. Laboratory diagnostic tests may include blood sugar levels, complete blood count, clotting time, and peripheral blood smear. Imaging examinations like eye ultrasound can help visualize the bleeding, optical coherence tomography (OCT) can help pinpoint the origin of ruptured vessels, and CT or MRI scans can detect brain hemorrhages that might affect the vitreous hemorrhage.

Management

The management of vitreous hemorrhage focuses on addressing both the bleeding and its underlying cause. A vitrectomy, which is a surgical procedure to drain the vitreous fluid, may be necessary if the retina is obscured. Additionally, if new blood vessels are visible in the forepart of the eye, related surgical procedures might be recommended by the doctor.

Therapies to stop bleeding from blood vessels include laser photocoagulation, a surgical technique using a laser to close broken or leaking blood vessels. If the vitreous remains unclear after one month, a vitrectomy may be performed.

Drug treatments can also be employed to reduce the growth of new, fragile blood vessels in the eyes that are prone to breaking.

When experiencing vitreous hemorrhage, it's important to:

• Avoid intense physical activities, such as lifting weights, as they can cause a sudden rise in blood pressure, potentially triggering another hemorrhage.
• Sleep with your head elevated at a 45-degree angle to help blood settle at the bottom of the eyeballs, allowing light to enter the eyes properly.
• Consult your doctor if you are taking blood thinners to determine if you need to stop them. If no significant eye damage is present, blood thinners may need to be continued under medical advice.

Complications

Complications of vitreous hemorrhage include hemosiderosis bulbi. This condition refers to damage to the ocular structure caused by iron ion binding. Red blood cells in the vitreous can break down into iron ions that permanently bind to ocular structures, causing damage to the particular structures.

Another complication is glaucoma, which can occur when hemoglobin from red blood cells blocks the fluid discharge pathway at the forepart of the eyeball, increasing intraocular pressure. Iron ions can also block these channels, leading to permanent damage.

In infants, vitreous hemorrhage complications can include amblyopia (lazy eye) and myopia (nearsightedness), necessitating immediate surgery.

Prevention

Preventing vitreous hemorrhage involves controlling blood sugar and blood pressure through a healthy diet, regular physical activity, and maintaining an ideal body weight. For individuals with diabetes or hypertension, adhering to medication regimens is crucial for controlling blood sugar levels and blood pressure. Additionally, studies suggest that administering drugs to prevent the growth of new blood vessels after surgery for vitreous hemorrhage can reduce the risk of recurrence.

When to See a Doctor?

Immediate medical attention is necessary if you experience sudden painless blurred vision without eye redness. Sudden blurred vision can result not only from vitreous hemorrhage, but can also come from various conditions affecting the retina or blood vessels, necessitating prompt treatment.

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