II. Definitions
- Vitreous Hemorrhage
- Blood extravasates into the vitreous cavity
III. Epidemiology
- Incidence: 7 per 100,00 per year in U.S.
IV. Pathophysiology
- Most commonly caused by Diabetic Retinopathy, Eye Trauma or Posterior Vitreous Detachment
- Even a small amount of blood (12.5 uL) in the 5 ml vitreous cavity can result in near complete opacification of Vision
-
Vision Loss may take months to improve, with only 1% cleared per day
- Clotted blood may remain suspended in the vitreous, before it settles to the floor of the chamber and is resorbed
- Mechanisms
- Normal Retinal blood vessel rupture
- Eye Trauma (44% of cases in age <40 years old, second most common cause overall)
- Posterior Vitreous Detachment
- Shaken Baby Syndrome
- Pathologic structure bleeding
- Neovascularized Retina in proliferative Diabetic Retinopathy (35% of all cases)
- Central Retinal Vein Occlusion (CRVO)
- Hemorrhage extension from other sources via the Retina
- Microaneurysms
- Tumors
- Normal Retinal blood vessel rupture
V. Risk Factors
- Diabetes Mellitus (Diabetic Retinopathy)
- Coagulopathy
- Retinal Tear (from Posterior Vitreous Detachment)
- Proliferative sickle Retinopathy (Sickle Cell Anemia)
- Eye Trauma
- Macular Degeneration
- Retinal artery micro-aneurysm
- Shaken Baby Syndrome
- Central Retinal Vein Occlusion (CRVO)
- Terson Syndrome (associated with Subarachnoid Hemorrhage)
- Occurs in 20-30% of SAH cases, and is associated with a worse prognosis
- Coagulopathy
VI. Symptoms
- Painless, unilateral Acute Vision Loss lasting for minutes to hours
VII. Signs
- Funduscopy
- Red Haze of Fundoscopy obscures the Retina
-
Pupil reflex
- Normal (consider Retinal Detachment if abnormal pupil reflex)
-
Slit Lamp
- Evaluate for Red Blood Cells in anterior chamber
VIII. Imaging
-
Ocular Ultrasound
- Excludes alternative diagnosis (e.g. Retinal Detachment)
- Vitreous Hemorrhages (location and size)
- Collections of irregular hyperechoic (white) blood suspended in anechoic (black) chamber
- Hemorrhages may swirl (as in a washing machine) with Extraocular Movement
IX. Management
- Urgent ophthalmology Consultation evaluation (best within 24 hours)
-
General, conservative measures
- Bedrest
- Elevate head of bed to 30 degrees
- Hold Anticoagulants if possible (including Aspirin and NSAIDs)
- Avoid strenuous activity (that might increase Blood Pressure and worsen spontaneous bleeding)
- Ophthalmology procedures
- Pars Plana Vitrectomy to remove blood collections from vitreous
- Timing of procedure is variable depending on cause
- In some cases, emergent vitrectomy is considered
- In Diabetic Retinopathy, vitrectomy is considered after the first month and may delayed up to 12 months
- Panretinal photocoagulation
- Indicated for proliferative Diabetic Retinopathy (to reduce recurrent bleeding risk)
- Pars Plana Vitrectomy to remove blood collections from vitreous
X. Prognosis
- Better prognosis if risk of recurrent bleeding is low (Vision improvement in >77% of cases)
- Poor prognosis when higher risk for recurrent bleeding
- Proliferative Diabetic Retinopathy (if not treated with photocoagulation)
XI. References
- Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
- Yu and Jasani (2024) Crit Dec Emerg Med 38(1): 27-34
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| Definition (NCI_CTCAE) | A disorder characterized by blood extravasation into the vitreous humor. |
| Definition (NCI) | Blood extravasation in the vitreous humor. Causes include neovascularization, retinal tear, retinal detachment, and rupture of a blood vessel aneurysm in the eye. |
| Definition (MSH) | Hemorrhage into the VITREOUS BODY. |
| Concepts | Pathologic Function (T046) |
| MSH | D014823 |
| ICD9 | 379.23 |
| ICD10 | H43.1 , H43.10 |
| SnomedCT | 31341008 |
| English | Hemorrhage, Vitreous, Vitreous Hemorrhages, VITREOUS HEMORRHAGE, VITREOUS HAEMORRHAGE, Vitreous Hemorrhage, vitreous hemorrhage (diagnosis), vitreous hemorrhage (physical finding), vitreous hemorrhage, Blood In Vitreous Fluid, Vitreous hemorrhage, unspecified eye, Vitreous Hemorrhage [Disease/Finding], vitreous haemorrhage, vitreous hemorrhages, disorder vitreous hemorrhage, hemorrhage vitreous, Vitreous bleeding, Vitreal hemorrhage, BLOOD IN VITREOUS FLUID, FLUID, BLOOD IN VITREOUS, VITREOUS FLUID, BLOOD IN, Vitreous hemorrhage, Intragel vitreous haemorrhage, Intragel vitreous hemorrhage, Vitreous haemorrhage, Vitreous hemorrhage (disorder), hemorrhage; vitreous body, vitreous body; hemorrhage, VH - Vitreous haemorrhage, VH - Vitreous hemorrhage |
| Italian | Emorragia vitreale, Sanguinamento del corpo vitreo, Emorragia del corpo vitreo |
| Swedish | Glaskroppsblödning |
| Japanese | ｼｮｳｼﾀｲｼｭｯｹﾂ, 硝子体出血, 出血-硝子体 |
| Czech | sklivec - hemoragie, Sklivcová hemoragie, Sklivcové krvácení, Krvácení do sklivce |
| Finnish | Lasiaisverenvuoto |
| Russian | KROVOIZLIIANIE V STEKLOVIDNOE TELO, STEKLOVIDNOGO TELA GEMORRAGIIA, КРОВОИЗЛИЯНИЕ В СТЕКЛОВИДНОЕ ТЕЛО, СТЕКЛОВИДНОГО ТЕЛА ГЕМОРРАГИЯ |
| Portuguese | HEMORRAGIA DO VITREO, Sangramento do vítreo, Hemorragia no vítreo, Hemorragia Vítrea |
| French | HEMORRAGIE DU VITRE, Saignement du corps vitré, Hémorragie du corps vitré, Hémorragie du vitré, Hémorragie intra-vitréenne, Hémorragie vitréenne |
| Korean | 유리체 출혈 |
| Polish | Krwotok do ciała szklistego |
| Hungarian | Üvegtesti vérzés, Üvegtest vérzés |
| Dutch | bloeding van glasvocht, bloeding; corpus vitreum, corpus vitreum; bloeding, glasvochtbloeding, Bloeding van het corpus vitreum, Bloeding, glasvocht-, Glasvochtbloeding |
| German | Bluten des Glaskoerpers, Glaskoerperblutung, Blutung, Glaskörper-, Glaskörperblutung, Hämorrhagie, Glaskörper- |
| Spanish | Sangrado del vítreo, hemorragia vítrea (trastorno), hemorragia vítrea, Hemorragia del vítreo, Hemorragia Vítrea |
| Norwegian | Blødning til corpus vitreum, Blødning til glasslegemet, Corpus vitreum-blødning, Glasslegemeblødning, Vitreus blødning, Vitreus hemoragi, Glasslegemehemoragi |
