Vitreous Hemorrhage: Causes, Symptoms & Treatment

Vitreous hemorrhage can have several causes. In many cases, medical treatment is limited. However, hemorrhages often resolve on their own.

What is a vitreous hemorrhage?

In a present vitreous hemorrhage, blood enters the so-called vitreous cavity of the human eye. The vitreous humor occupies about 80% of the available space in the human eyeball and is filled with a clear vitreous fluid. A vitreous hemorrhage can cause clouding of the vitreous. This is often associated with vision loss in affected individuals. A vitreous hemorrhage can take on different degrees of severity: A mild vitreous hemorrhage is manifested, for example, by a few dark spots appearing in the affected person’s field of vision. If a vitreous hemorrhage is very severe, it can limit vision to such an extent that the patient can, for example, only distinguish light from dark.

Causes

The most common cause of vitreous hemorrhage is a condition called diabetic retinopathy. This is a disease of the retina, the development of which is favored by an existing diabetes disease (sugar disease). In young people, vitreous hemorrhage is also frequently caused by external injuries to the eye. Other factors that can cause hemorrhages in the vitreous body are, for example, existing high blood pressure or occurring cerebral hemorrhages. A vitreous hemorrhage can also be caused by a detachment of the retina, which leads to bleeding of the retinal vessels. Hemorrhages in the vitreous body can also be a possible consequence of malignant neoplasms (such as vascular tumors) on the retina; bleeding in the eye can occur at a corresponding vascular tumor. Last but not least, various underlying diseases such as leukemia may finally promote vitreous hemorrhage.

Symptoms, complaints, and signs

The symptoms of vitreous hemorrhage depend on the extent of the hemorrhage in the vitreous. Initially, changes in image perception occur, manifested by dark-appearing opacities. These localized opacities are caused by blood inclusions under the vitreous. Patients describe them as black flakes, cobwebs or floating particles. Furthermore, those affected may perceive dots, moving shadows or even flashes of light. The flashes of light are already evidence of vitreous detachment. These sudden sooty rain-like flakes occur especially in the morning after getting up, since the blood moves violently back and forth under these conditions. Occasionally, visual field loss also occurs, with individual parts of the overall perceptible visual field appearing blind due to blood deposits. The visual field also turns reddish due to the blood. Overall, however, vitreous hemorrhages do not cause pain. If the hemorrhage is mild, the symptoms remain limited to those described above. Reductions in visual acuity need not then occur. However, if the hemorrhages are more severe, reversible visual loss may also occur. Reversible visual loss means a temporary reduction in visual acuity. Even with a blood volume of ten microliters, the reduction in visual acuity can be so severe that the patient can only recognize hand movements instead of sharp images. In severe cases, even reversible blindness is often observed. Vitreous hemorrhages may heal on their own. In severe or repetitive hemorrhages, the blood can no longer be reabsorbed, causing tears in the retina and even detachment.

Diagnosis and course

A suspected diagnosis of vitreous hemorrhage by an ophthalmologist may initially occur based on a patient’s described symptoms. To confirm such a diagnosis, an ophthalmologic examination with a so-called slit lamp or slit lamp microscope can be performed, for example. Here, a slit-shaped beam of light is directed at the patient’s eye to detect vitreous hemorrhage. If this examination method cannot provide clear results, it is possible in a further step to detect a vitreous hemorrhage with the aid of ultrasound procedures. The course of a vitreous hemorrhage differs depending on the patient and the severity of the bleeding.In principle, it is possible for a hemorrhage to regress on its own. This happens as the body reabsorbs the blood that has entered the vitreous. Such a process can last for several months and beyond. In severe cases, vitreous hemorrhage can lead to spontaneous blindness of the affected person.

Complications

Usually, vitreous hemorrhage is diagnosed late, allowing only delayed treatment. Symptoms also usually become apparent only as the disease progresses, with the patient’s field of vision becoming limited. This leads to black spots, which can limit the daily life of the affected person. The eyeball can also turn red. Due to the restrictions in the field of vision, however, it is not uncommon for psychological complaints and stress to occur. Headaches and dizziness may also occur, leading to a reduced quality of life. As the disease progresses, the visual acuity is reduced further and further, so that in the worst case complete loss of vision can occur. This blindness is not reversible and can no longer be treated. If the vitreous hemorrhage is treated at an early stage, no particular complications occur. The treatment is usually surgical and stops the bleeding. However, this does not exclude the possibility that the bleeding will recur in the patient. Life expectancy is usually not changed by vitreous hemorrhage. Furthermore, cataract formation may occur even after treatment.

When should you see a doctor?

Because vitreous hemorrhage is a serious complaint, it must always be examined and treated by a doctor. Early treatment can prevent further complications and discomfort to the eye. As a rule, a doctor should be consulted when bleeding occurs in the eye. In most cases, these bleedings are easily visible, so that other people can also point out the vitreous hemorrhage to the patient. Pain does not occur in most cases. Furthermore, the perception of colors can also change, so that the visual field looks reddish. A total loss of the visual field can also indicate a vitreous hemorrhage and must always be examined. Furthermore, visual complaints or even blindness may also occur. The first contact person in case of a vitreous hemorrhage can be an ophthalmologist. If the complaint occurs after an accident, an emergency doctor can also be called or the hospital can be visited directly. In most cases, this hemorrhage can be treated well so that there are no further complications.

Treatment and therapy

The therapy used in individual cases to treat vitreous hemorrhage depends first on the causes of the hemorrhage. If the hemorrhage is a symptom of an underlying disease, consistent treatment of this underlying disease is one of the goals of therapy. If it could be determined by the ophthalmologist that a vitreous hemorrhage is not the result of retinal damage (or that the retina is intact), physicians often advise waiting for the natural breakdown of the blood that has entered the vitreous to occur first. One of the reasons for this is that the options for treating a vitreous hemorrhage with medication are very limited. One of the risks of not taking therapy is that any bleeding that occurs can persist. In severe cases it is possible to treat a vitreous hemorrhage surgically. However, such an intervention may promote postoperative occurrence of retinal detachments or eye diseases such as cataracts. During a surgical procedure, the vitreous affected by the vitreous hemorrhage is usually removed. The vitreous fluid is replaced with a fluid that may be based on a saline solution, for example.

Outlook and prognosis

The prognosis of vitreous hemorrhage depends on the stage of the disease as well as the causative disorder. In addition, spontaneous cures are documented in many patients, so natural relief and subsequent freedom from symptoms can occur at any time, even without therapy. The difficulty of the disorder lies in an early diagnosis as well as the possibility of treatment of the disease. The more advanced the vitreous hemorrhage, the less favorable the coming course of the disease.Without medical treatment, a large number of patients gradually develop an increasing loss of vision until the person is ultimately completely blind. This condition is irreversible and triggers psychological problems or secondary diseases in most patients. If the retina is damaged, the prognosis is also worse. Surgical intervention is necessary, which is associated with risks and side effects. If the causative triggers of vitreous hemorrhage can be treated well and the blood formed can be drained, the prospect of subsequent freedom from symptoms is favorable. This is especially true for patients who have not experienced severe visual impairment and have no other ocular diseases. During the course of life, vitreous hemorrhage may recur. The prognosis remains unchanged if the symptoms recur.

Prevention

There is only limited prevention of vitreous hemorrhage. However, regular ophthalmologic checkups are usually important. This is because various diseases that can lead to hemorrhage in their course can be detected and treated at an early stage. For example, an incipient retinal detachment that is diagnosed in time can be stopped and thus a vitreous hemorrhage can be prevented.

Follow-up

Aftercare for vitreous hemorrhage consists of two parts. For example, the eye in which the intravitreal hemorrhage occurred must still be followed up at least once, but usually several times, to rule out further bleeding and to observe healing. If necessary – if medications were used – further agents will be prescribed. In addition, the eye should be checked for possible secondary damage. An ophthalmologist has the necessary equipment to check the inside of the eye well. More important, however, is finding out the cause of the hemorrhage. While this is easy in the case of accidents and forces on the face, spontaneously occurring vitreous hemorrhages are a reason for further investigations. For example, various diseases can be considered as the cause. Among them are for example an unknown diabetes, a retinal detachment or tumors. Furthermore, the usual follow-up measures after surgical interventions on the eye are also necessary. This is especially true if vessels have been surgically treated or if tears in the eye have been treated. The healing of wounds or bleeding in the eye takes a long time, which is why there should be several follow-up examinations. During these, agents may be prescribed to accelerate the breakdown of blood in the vitreous, if necessary.

What you can do yourself

Patients with vitreous hemorrhage are able to help themselves through various measures and thereby both relieve the acute symptoms and positively influence the long-term course of the disease. It is always important to follow the instructions of the treating physician. To support the initial treatment with the aim of stopping bleeding, the patient maintains an upright, calm position. Accordingly, the head is above the trunk and extremities so that the amount of blood accumulates in the lower zone of the eye. During the disease, physical activities should be reduced in order not to aggravate the course of the disease. The same applies to sports, especially weight training and competitive sports. Any sporting activity should be coordinated with the specialist. This increases the chance that the bleeding will decrease more quickly and the patient will regain his usual quality of life. If surgical treatment of vitreous hemorrhage is necessary, the affected person supports the chances of success of the procedure by leading a healthy lifestyle. A strengthened immune system and consideration for the special hygienic requirements before and after surgery in the area of the eye promote healing. Throughout the disease, the eyes should be protected and prevented from overexertion by, for example, not exposing the patient to extreme weather conditions and minimizing the use of screens.