25th December 2023

Vitreous haemorrhage

Vitreous haemorrhage is the presence of blood in the vitreous cavity. The source may be from retinal neovascularisation, rupture of healthy retinal vessels or trauma. Causes include:

• Proliferative diabetic retinopathy (PDR)
• Retinal vein occlusion (RVO)
• Sickle cell retinopathy
• Trauma: blunt or penetrating
• Posterior vitreous detachment
• Blood dyscrasias (Leukaemia, anaemia, thrombocytopenia, haemophilia)
• Iatrogenic: following intra-ocular procedures

Clinical presentation

Patients experience a sudden onset or a shower of floaters, which may or may not obscure the vision. Visual acuity is moderately to severely reduced. The presence of a relative afferent pupillary defect (RAPD) should prompt concern for an associated retinal detachment. Vitreous haemorrhage that is obscuring fundus examination mandates a B-ultrasound scan. This will confirm vitreous echoes and allow visualisation for an associated retinal detachment or posterior wall masses. Ocular ultrasound should not be performed in traumatic cases where there is suspicion of a globe rupture.

Management

All suspected vitreous haemorrhages should be referred to Ophthalmology for full assessment and monitoring. Treatment is aimed at the underlying cause. Surgical intervention (vitrectomy) may be required for non-clearing or repeated vitreous haemorrhage.