Vitreous Haemorrhage

Question 1

What is vitreous haemorrhage?

Answer 1

Extravasation or leakage of blood into the areas in and around the vitreous humour of the eye

Question 1

Three main causes of vitreous haemorrhage

Answer 1

1. Abnormal vessels
   -Diabetic retinopathy (proliferative)- over 50%!
   -Neovascularization from branch or central retinal vein occlusion
   -Sickle cell retinopathy
   -Vasculitis
2. Rupture of normal vessels
   -Retinal tear
   -Trauma!
   -Posterior vitreous detachment with retinal!
   -Vascular tear
   -Retinal detachment
   -Terson’s syndrome
3. Blood from adjacent source
   -Macroaneurysm
   -Age-related macular degeneration

Question 2

Symptoms and signs of VH

Answer 2

-Sudden painless visual loss or haze
-Floaters/ sudden shower rain
-Cobwebs,
-Shadows or a red hue in vision
-Visual field defect if severe/ scotomas/ decrease VA
-Photopsia

-Red fundus reflex may be absent
-No view to the fundus
-Red blood cell may be seen in anterior vitreous
-Chronic VH has a yellow ochre appearance from Hb breakdown

Question 3

Management of VH

Answer 3

-Identify cause
-Look at the contralateral eye
-USG B can
-Observe
-Surgery/ PRP

Question 4

Investigations in vitreous haemorrhage

Answer 4

-Dilated fundoscopy: may show haemorrhage in the vitreous cavity
-Slit-lamp examination: red blood cells in the anterior vitreous
ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
-Fluorescein angiography: to identify neovascularization
-Orbital CT: used if open globe injury