Synonyms
Medical: Intravitreal bleeding
Definition vitreous hemorrhage
A vitreous hemorrhage is the penetration of blood into the vitreous cavity of the eye. This is located behind the lens of the eye. Depending on the amount of blood entering during a vitreous hemorrhage, it can cause varying degrees of symptoms.
At the beginning, the patient notices short-term changes in the image perception: dark appearing opacities described as black flakes or soot flakes. Other descriptions speak of “cobwebs” or suspended particles. Many patients describe moving shadows and spots to be seen.
Another symptom may be (light) flashes that the patient perceives, although these may also indicate a vitreous detachment. These suddenly appearing mosquito swarms or sooty rain-like spots in the visual field come from the blood, which is in the vitreous cavity and moves back and forth following the force of gravity. This is why those affected usually complain about these complaints in the morning after getting up.
The visual field describes the points that the human eye can perceive if no fixation of objects or head movement is performed. The diagnosis of vitreous hemorrhage is made by the ophthalmologist by having the patient’s symptoms described and then looking into the eye with the slit lamp. As a rule, the bleedings are easily visible.
The ophthalmologist (specialist in ophthalmology) examines the eye thoroughly for the retinal hole. If the assessment is poor, an ultrasound of the eye may also be necessary. The type of treatment of a vitreous hemorrhage depends on various factors.
On the one hand, the strength of the bleeding and on the other hand whether it is a first-time occurrence. Before therapeutic measures are taken, there are suggestions for the behavior of patients in the case of a vitreous hemorrhage. The patient should take a resting position.
This means that he should position himself upright (upper body elevation) and remain so. By not moving the head and body, a worsening of the symptoms should be counteracted. If possible, the blood that is in the vitreous body and causes the problems should not spread further; however, if the head were to move, there would be a risk that the blood would spread to parts of the vitreous body that are not yet affected.
This would further worsen the symptoms. A further advantage of keeping still is that blood that has already been stirred up settles more quickly and thus fewer parts of the vitreous body are affected by the blood streaks. In addition, as a first therapeutic measure, a bandage can be applied to both eyes (binoculus).
This is a roll bandage which is applied around the eyes and the head. This is intended to support the immobilization of the eyes in addition to the above-mentioned behavior. Other behavioral suggestions describe that the patient continues to move normally without adopting a resting position.
Here it is assumed that a faster spontaneous resorption can take place due to the distribution of blood. The main opinion, however, is that the above mentioned mechanisms for immobilization of head and eyes are responsible for this. If the vitreous hemorrhage is reduced naturally and the symptoms subside, this is called spontaneous resorption.
This should occur within the next few days after a bleeding event. If it is a smaller and first-time vitreous hemorrhage, you can wait a few days to see whether spontaneous resorption sets in. If this occurs, the origin of the bleeding must be clarified in the next step, e.g. a retinal vessel (retina).
In such a case, treatment can be carried out by laser coagulation. This is based on the fact that the affected vessels are sclerosed. The laser destroys the cells in this area of the retina – they become necrotic (die off).
However, these are very small areas of the retina, so that the patient usually cannot perceive them. However, if there is a strong, prolonged or recurrent bleeding, surgical removal of the vitreous body (vitrectomy) should be considered. In these cases there is usually too much blood in the vitreous body to be completely absorbed (broken down).
Another indication for vitrectomy is when a retinal detachment or tears in the retina are diagnosed.In a vitrectomy, the vitreous body is removed or suctioned off. The vitreous body, which is part of the central part of the eye, maintains the shape of the eye – it ensures that the eye does not collapse. For this reason, during a vitrectomy the space created is filled with infusion solution so that the intraocular pressure can be maintained.
In this operation, several smaller, millimeter-sized incisions are made at the edge of the cornea. Through these incisions the surgical instruments are inserted: a lighting device, the infusion and other tools such as scissors and hooks. This work is performed under a microscope.
There have been reports in specialist literature of occasional successful treatments with homeopathic remedies, for example of a severely overweight patient with long-standing diabetes who had suffered a severe loss of vision (loss of visual acuity) due to a vitreous hemorrhage. He took Phosphorus D 30 for three days and almost regained his original vision. However, it is impossible to say whether the body would not have eliminated the bleeding completely on its own after three days without the aid of the patient.
Further positive results were achieved with the treatment with potassium chloratum and witch hazel, with similarly difficult to prove effects. Possible causes include bleeding from retinal vessels. This occurs when the retina detaches from its support.
Vessels can tear off and cause this bleeding. Other possible causes are
- Increased vascularization in diabetics or occlusion of the central retinal vein
- Small dilatations of retinal vessels or calcifications of the same
- Bleeding from a vascular tumor of the retina
It is difficult to prevent vitreous hemorrhage, as it is usually caused by a retinal detachment. A retinal detachment is a very serious disease that can lead to blindness.
In vitreous hemorrhage, blood enters the so-called vitreous cavity of the human eye. The vitreous cavity makes up about 80% of the total area of the eye and is usually filled with a clear, transparent liquid. The blood that enters the vitreous body can cloud the liquid inside, which then leads to a disturbing limitation of vision, a generally blurred vision and, due to the red dye haemoglobin in the blood, a generally reddish coloration of the environment.
How severe this impairment is perceived depends on the strength and extent of the bleeding. In mild cases, patients notice a few dark spots in the field of vision. These are not further problematic, but are described as extremely annoying.
However, if the bleeding is more severe, the patient’s vision may be directly affected and may be so severely reduced that only light-dark can be perceived or vision may be almost completely lost. However, this happens only very rarely and would be the “worst case” scenario, so to speak. The causes of a vitreous hemorrhage can be very diverse.
The most common one is diabetic retinopathy, where a longer lasting diabetes slowly and gradually leads to clouding of the retina. Another large group of patients is found among extreme athletes or young people with physically demanding, dangerous jobs. Here, external injuries can lead to bleeding into the vitreous cavity.
Another risk factor for triggering a vitreous hemorrhage is psychological stress, as it can cause latent high blood pressure, making the occurrence of a hemorrhage more likely. Since the causes are so diverse, so are the therapeutic approaches. In general, the first thing one tries to do is to identify and treat any underlying disease.
However, relatively little can be done against the blood in the vitreous body itself. As long as the retina itself is not damaged, it is common practice to simply let the body’s self-healing processes work, which through natural processes ensure that the blood is gradually broken down, thus improving vision. This is because we want to protect the eye, which is a very small but all the more sensitive organ, as far as possible from surgical interventions, as these always carry the risk of secondary bleeding or other complications.However, if an operation is unavoidable, one is able to suck out the fluid in the vitreous body together with the blood and replace it with an artificially produced replacement solution, usually based on salt or similar.
The duration of a vitreous hemorrhage, like the causes, is very variable and depends primarily on the severity of the bleeding. If it is only a moderate form of hemorrhage and the affected person is not further restricted in his or her everyday life by the symptoms that occur (such as dark spots in the field of vision, the slightly reddish-orange clouding and possibly small failures of the visual field), doctors do not recommend further treatment but, as unusual as it may sound, simply wait and let the body’s own self-healing processes work. The body is able to eliminate bleeding completely without help, as anyone who has ever had a bruise can safely observe.
Depending on the extent of the bleeding and how fit and healthy the body is, this process can take several months, which is completely normal. If you decide to undergo surgery because of the massive bleeding or other complications, the bleeding itself is quickly eliminated, but as mentioned above, you must take it easy on your body for some time after the operation. The subject of sports is important in connection with vitreous hemorrhages in two ways.
On the one hand, sports, especially physically dangerous sports or extreme sports in general, increase the risk of developing a vitreous hemorrhage. This is due to the fact that such a vitreous hemorrhage can also be triggered by external injuries in the head area or the eye itself. And the more hard body contact, for example during rugby or similar, the higher the probability of being injured in the eye.
And in the meantime, a very sharp rise in blood pressure can occur in many extreme sports, and high blood pressure in turn increases the risk of bleeding. In the case of high blood pressure-related bleeding, the small and smallest vessels, such as the blood vessels in the eye, are the first to rupture, and this is where bleeding is most likely to occur. Another important aspect of sports in connection with a vitreous hemorrhage is its avoidance, should one have decided on surgical removal of the bleeding and thus surgical removal of the vitreous (vitrectomy).
In this procedure, needles are inserted through three very small punctures in the eye, through which the gel-like fluid that fills the vitreous body, together with the disturbing blood in it, is sucked out. The resulting empty space is usually filled with air, gas or a silicone oil, which, due to the laws of physics, behave in such a way that they cannot easily escape from the eye by themselves, and the needles are removed. The procedure lasts about 30-60 minutes and is performed as an inpatient, the patients remain in hospital for three to six days, depending on the course of the operation.
After the operation, it is important that the patient is positioned in a certain way, especially the head. The pain is kept very low due to the minimally invasive technique. Sometimes there is a certain foreign body sensation in the eye for a few days after the operation.
In the period after the surgery, the patient is not allowed to make any great physical exertion, which of course includes sports activities. Here, too, the risk of injury and the danger of a rise in blood pressure are of primary importance. Furthermore, there is talk of possible visual field failures, which means that certain parts of the maximum perceivable space appear blind.
This can have various causes, including a vitreous hemorrhage. Further symptoms are a discoloration of the visual field into a dull reddish color. The red color is also caused by the vitreous hemorrhage.
In the case of a slight vitreous hemorrhage, it is possible that there is no reduction in visual acuity in addition to the perceived changes in the visual field. However, the stronger the vitreous hemorrhage is, the higher the probability of a reduction in visual acuity. Basically, even a quantity of blood from 10μl can cause a reduction in visual acuity in which the patient can barely perceive hand movements.The vitreous hemorrhage can also be so pronounced that the attending physician has difficulty seeing into the eye and the patient suffers reversible blindness (this is reversible, i.e. it is not permanent blindness).
The bleeding typically causes no pain; we speak of a painless loss of vision. The symptoms of vitreous hemorrhage can depend on the intensity of the bleeding, as described above. With regard to the persistence of the symptoms, it can be assumed that they will be reduced by the decomposition of the invaded blood. This topic might also be of interest to you: Vitreous detachment
