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Vitreous Hemorrhage

A vitreous hemorrhage refers to a bleed (hemorrhage) within the vitreous cavity. The vitreous cavity is located behind the natural lens of the eye and in front of the retina. Symptoms include noting many new black opacities within the vision (floaters), a red hue, and severe vision loss.

Causes of Vitreous Hemmorrhage

There are two main causes: 

  • Pulling forces on retinal blood vessels (retinal traction)
  • New blood vessel growth (neovascularization)

Causes of Retinal Traction

There are two common conditions that may cause retinal traction:

Posterior vitreous detachment – A separation of the vitreous (gel) from the back of the eye towards the front of the eye. The gel may pull on the retinal vessels, causing a hemorrhage.

Retinal tear with or without detachment – The vitreous may pull hard enough that it tears the retina. This may or may not be accompanied by a hemorrhage. This frequently warrants same-day evaluation and treatment.

There is a myriad of conditions that may cause new blood vessel growth (neovascularization). Retinal vascular diseases may cause poor blood flow to the retina. This results in the secretion of a hormone called vascular endothelial growth factor. This hormone causes the formation of abnormal blood vessels which may leak and bleed.

The most common examples include:

Patients with these symptoms should see their retina specialist promptly. The key to hemorrhage clearing is to allow the blood to settle along the bottom of the eye using gravity. This will allow the blood to move away from the part of the retina responsible for central vision. It can be beneficial to maintain the head of the bed elevated (sleep with at least 2 pillows or in a recliner). Avoid bending (causes the blood to disperse again). Avoid heavy lifting or straining. Avoid high-impact activities or fast eye movements (causes dispersion of the blood).

Treatment for Vitreous Hemorrhage

Retinal tears are typically treated with an in-office laser procedure.

Retinal detachments may be repaired in the office or operating room.

Patients who have new blood vessel growth will typically undergo an in-office treatment with laser or an intravitreal injection.

Patients whom do not experience improvement in vitreous hemorrhage with medical treatment may be offered surgical intervention.

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