Vitreous Haemorrhage Flashcards
(20 cards)
What is the vitreous humor?
- The vitreous humor is a transparent, colorless, jelly-like, hydrophilic gel
- Helps in maintaining the transparency and structure of the eye.
- Its volume in an adult eye is around 4ml, which is nearly 80% of the globe
- It is composed of 98to 99% water, and the rest is collagen, hyaluronic acid, and electrolytes.
What is vitreous hemorrhage?
Vitreous hemorrhage is the extravasation of blood from vessels into the vitreous humor
Epidemiology of VH?
- Vitreous Hemorrhage is a relatively common cause of acute vision loss
- In young population the most common cause is trauma.
- In adults, proliferative diabetic retinopathy is the most frequent cause of vitreous hemorrhage
Types of vitreous hemorrhage?
- Pre retinal
- Sub-hyaloid hemorrhage
- Sub-internal limiting membrane hemorrhage - Intravitreal or intragel
- Blood freely dispersed within the vitreous gel.
- Has no specific shape
- The color of the blood may vary from red to yellow, depending on the extent of the degeneration of red blood cells (RBCs)
What does a preretinal VH look like?
boat-shaped or d-shaped appearance
What does intraretinal VH look like?
- Poor retinal visibility due to blood scattered throughout the vitreous body.
- The hemorrhage is not well-demarcated or layered, unlike sub hyaloid hemorrhage.
Categories of VH?
- abnormal vessels that are prone to rupture and bleed
- rapture of normal vessels
- hemorrhage from adjacent source
Abnormal vessels prone to rupture and bleed are seen in?
Proliferative diabetic retinopathy
Sickle cell retinopathy
Ocular ischemic syndrome
Retinal vein occlusion
Age related macular degeneration
Rupture of normal vessels is seen in?
- Blunt or penetrating trauma
- Terson’s syndrome
Hemorrhage from adjacent source is seen in?
Tumors
Retinal microaneurysm
choroidal neovascularization
Risk factors for VH?
Diabetes retinopathy
Hypertension
Sickle cell disease
Ocular trauma or surgery
Blood disorders (e.g., thrombocytopenia, leukemia)
Use of anti-coagulation drugs
Symptoms of VH?
Floaters
blurring of vision
Flashes of light and visual distortion indicative of retinal involvement.
Sudden painless vision loss
Signs of VH?
- Blood in vitreous cavity on ophthalmoscopic examination
- Absent or diminished red reflex
Clinical examination of VH?
Visual acuity assessment.
Slit-lamp examination (for anterior segment and vitreous clarity).
Fundoscopy (if the view is not obstructed).
Ddx of VH?
Proliferative diabetic retinopathy
Retinal vein occlusion
Retinal tear/detachment
Hypertensive retinopathy
Sickle Cell retinopathy
Globe injury
Various blood disorders/coagulopathies
Age-related macular degeneration
Investigations of VH?
- Lab studies
- Blood sugar
- Full blood count
- Coagulation profile - Imaging
- Ocular ultrasound( A and B scan)
- Brain and orbital CT and MRI
Medical management of VH?
Observation: Small hemorrhages may resolve spontaneously
Head elevation: Encourages blood to settle inferiorly, improving vision.
Avoidance of anticoagulants
Intravitreal anti-VEGF injections
e.g Bevacizumab
Surgical management of VH?
- Laser photocoagulation
- Pars plana vitrectomy (PPV) in severe cases
Prognosis of VH?
- The prognosis is variable according to the etiology, status of optic nerve, and macular involvement
- patients with vitreous hemorrhage secondary to proliferative diabetic retinopathy or age-related macular degeneration will have a more guarded prognosis compared to those with vitreous hemorrhage resulting from posterior vitreous detachment.
Complications of VH?
Hemosiderosis bulbi with photoreceptor toxicity
Ghost cell glaucoma
Hemolytic glaucoma
