Vitreus 713e

VITREOUS HAEMORRHAGE

DEFINITION Bleeding into the vitreous chamber or a space created by vitreous detachment. Vitreous haemorrhage usually occurs from the retinal vessels and may present as pre-retinal (sub-hyaloid) or an intragel

haemorrhage. The intragel haemorrhage may involve anterior, middle, posterior or the whole vitreous body.

ETIOLOGY 1.

Spontaneous vitreous haemorrhage from retinal breaks especially those associated with PVD.

2.

Trauma to eye, which may be blunt or perforating (with or without retained intraocular foreign body) in nature.

3.

Inflammatory diseases such as erosion of the vessels in acute chorioretinitis and periphlebitis retinae primary or secondary to uveitis.

4.

Vasculardisorderse.g.,hypertensiveretinopathy, and central retinal vein occlusion.

5.

Metabolic diseases such as diabetic retinopathy.

6.

Blood dyscrasias e.g., retinopathy of anaemia, leukaemias, polycythemias and sickle-cell retinopathy.

7.

Bleedingdisorderse.g.,purpura,haemophiliaand scurvy.

8.

Neoplasms.Vitreoushaemorrhagemayoccurfrom rupture of vessels due to acute necrosis in tumours like retinoblastoma.

9.

Idiopathic

PATHOMECHANISMS

SYMPTOMS Sudden development of floaters occurs when the vitreous haemorrhage is small. In massive vitreous haemorrhage, patient develops sudden painless loss of vision.

SIGNS Distant direct ophthalmoscopy reveals black shadows against the red glow in small haemorrhages and no red glow in a large haemorrhage. Direct and indirect ophthalmoscopy may show presence

of blood in the vitreous cavity. Ultrasonography with B-scan is particularly helpful in diagnosing vitreous haemorrhage.

FATE OF VITREOUS HAEMORRHAGE 1. Complete absorption may occur without organization and the vitreous

becomes clear within 4-8 weeks. 2. Organization of haemorrhage with formation of a yellowish-white debris occurs in persistent or recurrent bleeding.

3. Complications like vitreous liquefaction, degeneration and khaki cell glaucoma (in aphakia) may occur. 4. Retinitis proliferans may occur which may be complicated by tractional retinal

detachment.

TREATMENT • Conservative treatment consists of bed rest, elevation of patient’s head and

bilateral eye patches. This will allow the blood to settle down. • Treatment of the cause. Once the blood settles down, indirect ophthalmoscopy should be performed to locate and further manage the causative lesion such as a

retinal break, phlebitis, proliferative retinopathy, etc. • Vitrectomy by pars plana route should be considered to clear the vitreous, if the haemorrhage is not absorbed after 3 months

PROGNOSIS Absorption of a vitreous hemorrhage is a long process. The clinical course will depend on the location, cause, and severity of the bleeding. Bleeding in the vitreous body itself is absorbed particularly slowly.