Retina
Vitreous Hemorrhage
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Vitreous Hemorrhage
Pathophysiology
Most commonly caused by
Diabetic Retinopathy
,
Eye Trauma
or
Posterior Vitreous Detachment
Mechanisms
Normal blood vessel rupture (e.g.
Eye Trauma
,
Vitreous Detachment
,
Shaken Baby Syndrome
)
Pathologic structure bleeding (e.g. neovascularized
Retina
in
Diabetic Retinopathy
,
CRVO
)
Risk Factors
Diabetes Mellitus
(
Diabetic Retinopathy
)
Coagulopathy
Retina
l Tear (from
Posterior Vitreous Detachment
)
Proliferative sickle
Retinopathy
(
Sickle Cell Anemia
)
Eye Trauma
Macular Degeneration
Retina
l 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
Thrombocytopenia
Idiopathic Thrombocytopenic Purpura
Hemophilia
Leukemia
Symptoms
Acute Vision Loss
lasting for minutes to hours
Visual
Floaters
or "cobwebs"
Red visual hue
Often worse in the morning after the blood has settled over the
Macula
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 Cell
s in anterior chamber
Imaging
Ocular Ultrasound
May reveal Vitreous Hemorrhages
Management
Urgent ophthalmology evaluation within 24 hours
Panretinal photocoagulation (for proliferative photocoagulation)
Pars Plana Vitrectomy (
Retinal Detachment
)
Bedrest
Elevate head of bed to 30 degrees
Hold
Anticoagulant
s if possible (including
Aspirin
and
NSAID
s)
Avoid strenuous activity (that might increase
Blood Pressure
and worsen spontaneous bleeding)
Management
Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
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