Retina

Vitreous Hemorrhage

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Vitreous Hemorrhage

  • Pathophysiology
  1. Most commonly caused by Diabetic Retinopathy, Eye Trauma or Posterior Vitreous Detachment
  2. Mechanisms
    1. Normal blood vessel rupture (e.g. Eye Trauma, Vitreous Detachment, Shaken Baby Syndrome)
    2. Pathologic structure bleeding (e.g. neovascularized Retina in Diabetic Retinopathy, CRVO)
  • Risk Factors
  1. Diabetes Mellitus (Diabetic Retinopathy)
  2. Coagulopathy
  3. Retinal Tear (from Posterior Vitreous Detachment)
  4. Proliferative sickle Retinopathy (Sickle Cell Anemia)
  5. Eye Trauma
  6. Macular Degeneration
  7. Retinal artery micro-aneurysm
  8. Shaken Baby Syndrome
  9. Central Retinal Vein Occlusion (CRVO)
  10. Terson Syndrome (associated with Subarachnoid Hemorrhage)
    1. Occurs in 20-30% of SAH cases, and is associated with a worse prognosis
  11. Coagulopathy
    1. Thrombocytopenia
    2. Idiopathic Thrombocytopenic Purpura
    3. Hemophilia
    4. Leukemia
  • Symptoms
  1. Acute Vision Loss lasting for minutes to hours
    1. Visual Floaters or "cobwebs"
    2. Red visual hue
    3. Often worse in the morning after the blood has settled over the Macula
  • Signs
  1. Funduscopy
    1. Red Haze of Fundoscopy obscures the Retina
  2. Pupil reflex
    1. Normal (consider Retinal Detachment if abnormal pupil reflex)
  3. Slit Lamp
    1. Evaluate for Red Blood Cells in anterior chamber
  • Imaging
  1. Ocular Ultrasound
    1. May reveal Vitreous Hemorrhages
  • Management
  1. Urgent ophthalmology evaluation within 24 hours
    1. Panretinal photocoagulation (for proliferative photocoagulation)
    2. Pars Plana Vitrectomy (Retinal Detachment)
  2. Bedrest
  3. Elevate head of bed to 30 degrees
  4. Hold Anticoagulants if possible (including Aspirin and NSAIDs)
  5. Avoid strenuous activity (that might increase Blood Pressure and worsen spontaneous bleeding)
  • Management
  1. Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11