Vitreous Haemorrhage 

Vitreous haemorrhage occurs when blood vessels bleed into the clear, jelly-like fluid in the back of the eyes. This fluid is called vitreous humour, which helps the eyes maintain their shape and allows the passage of light through your eye to the retina. 

The degree of vitreous haemorrhage differs from mild, which causes floaters, to severe, characterised by blurred vision and vision loss. This condition doesn't cause pain and occurs quickly, usually affecting one eye. 

The condition requires urgent care and treating the bleeding can resolve the issue and restore vision. 

What is a vitreous haemorrhage?

This condition occurs due to blood entering the vitreous humour in the centre of the eye. Blood from the vessels usually leaks to the rear side of the eye. Bleeding in the eye may occur when blood vessels become damaged from tear in retina, trauma, or  or fragility due to diabetic retinopathy. 

Your vitreous humour must remain clear to see clearly, but your vision will be affected when filled with leaked blood or clouded. The result may be floaters, clouded vision or a complete dark or reddish tinge. 

What is vitreous humour?

Vitreous humour is a transparent substance, making up 80% of the eye volume. This jelly-like substance supports the eye shape and allows light to pass through. The vitreous humour consists more of water with a small percentage of hyaluronic acid and collagen. The outer part has fine fibres attached to the eye's retina and the lens in front. 

What is the prevalence of vitreous humour?

Vitreous humour occurs in about 7 in 100,000 persons per year, making it a common cause of sudden visual impairment. This condition usually occurs in one eye. 

Who can have a vitreous haemorrhage?

Severe diabetes that causes eye disease, usually affecting older adults, is the main cause of vitreous haemorrhage. Besides eye trauma, or retina tear other conditions that cause vitreous haemorrhage usually affect older adults from age 60. 

What causes vitreous haemorrhage?

Common causes of vitreous haemorrhage, accounting for up to 90% of this condition, include:

• Bleeding from tears in the retina resulting from vitreous detachment(PVD)or traction. 
• Bleeding from irregular new vessels present in the advanced stages of eye disease resulting like diabetes 
• Eye trauma, accounting for more cases in younger adults 

Bleeding in the eye often occurs from:

1. Abnormal eye blood vessels growing due to oxygen shortage to the eye's rear side. These blood vessels are usually fragile and usually bleed easily  

• Macular degeneration 
• Diabetic eye disease 
• Retinopathy resulting from sickle cell disease 
• Retinal vein occlusion 
• Damage occurring in the back of the eye in premature babies receiving oxygen in special care units for babies 

1. Damage to the normal eye blood vessels. The damage may result from:

• Vitreous detachment (PVD) in the posterior side of the retina that causes a tear in the retina 
• Blunt trauma which suddenly compresses the eye 
• Retinal micro aneurysms – swollen retinal blood vessels resulting from smoking, atherosclerosis and high blood pressure 
• Penetrating trauma – resulting in bleeding in the eyes. This may occur from severe injuries from hammering and grinding but may not result in severe pain in the eye 
• Surgery in the eye, especially if it reaches inside the posterior (back) of the eye 
• Subarachnoid haemorrhage – this increases pressure in the retinal veins

1. Blood from the back of the retina, flowing into the eye (it is the rarest cause of haemorrhage in the vitreous humour), resulting from:

• Fragile new blood vessels at the rear side of the retina 
• Eye tumours that affect the eye's rear side. Eye tumours rarely occur, but the most prevalent is ocular melanoma. 

Vitreous detachment in the posterior side of the retina often affects people in their middle age or sooner in shortsighted individuals. This condition occurs due to detachment of the vitreous humour from the retina's back area. The detachment can be sudden because the vitreous shrinks as we age. It usually shows no symptoms. 

In some cases, vitreous detachment in the posterior side of the retina leads to bleeding from the retina. The retina may also become torn as it pulls by the traction of jelly(the vitreous humour). In people with posterior vitreous haemorrhage, frequent bouts of floaters occur due to the tiny bleeding. 

What symptoms do vitreous haemorrhage cause?

Smaller bleeds are more common, and their symptoms include floaters, haze, shadows and cobwebs in the eye. Some people may experience a reddish tint in their vision. Severe bleeds may lead to hazy vision and, in some cases, dark streaks or blind spots. 

The most serious bleeding can cause complete blindness. This is usually alarming as the change in vision is usually sudden. 

Diagnosis of vitreous haemorrhage 

The doctor will examine your eyes using the slit lamp. This device helps your ophthalmologist carry out an extensive eye exam to check if blood is present inside the vitreous. 

The surgeon can find the bleeding site using a slit lamp, but if blood present inside the vitreous is much, it will prevent a good view for determining the cause of the bleeding. In cases like this, the doctor will carry out an eye ultrasound. 

The ultrasound will identify the vitreous haemorrhage, such as foreign objects, tumours, retinal detachments and tears, and posterior vitreous detachment. In some cases, an angiogram test is necessary. This test will show the eye's blood vessels on the rear side. An angiogram helps check for abnormal eye blood vessels resulting from conditions like diabetes. 

If the doctor suspects a penetrating injury, you may have to undergo a computerised tomography or CT scan of the eyes. 

What can treat vitreous haemorrhage 

Treatment for vitreous haemorrhage differs depending on the cause. The treatments usually aim for the following:

• Find the cause of bleeding 
• Stop bleeding 
• Treat damages to the retina to prevent permanent vision loss
• Restore vision 

When the doctor identifies the cause of your bleeding, they will recommend treatment depending on the assessment outcome. Treatment will follow if the bleeding is minimal and they find its source. The treatment may include laser treatment on the bleeding vessel and repairing retinal tears. After the treatment, you will wait for the leaked blood to gradually clear from the vitreous humour, usually taking a few weeks. 

Your doctor will advise you against engaging in strenuous and stressful activity for at least a few days to prevent dislodging the blood clots and triggering bleeding again. You have to elevate your head while sleeping to help the blood in the vitreous settle to the lower part of your eye, away from your visual line. 

If blood obstructs vision and prevents treating the cause of the bleeding, the doctor will first remove the vitreous with a vitrectomy procedure. 

Specific treatments 

Common specific treatments include:

• Laser photocoagulation 

This is the common treatment for weak, abnormal blood vessels. Treating these vessels stops any bleeding and will prevent further bleeding. You may also undergo laser photocoagulation to repair damages to your retina, such as retinal detachment. 

• Anti-VEGF injections 

This treatment shrinks the abnormal new blood vessels inside the eye. Some patients who have diabetes will need this treatment alongside treatments like vitrectomy and laser photocoagulation. 

• Cryotherapy 

It may be necessary for treating retinal detachments and tears in periphery of your retina. 

• Vitrectomy 

This procedure involves removing the vitreous humour, including the membrane surrounding it. Vitrectomy is necessary when excess blood inside the vitreous prevents diagnosis and treatment. The doctor may also recommend this treatment if the blood present in the vitreous humour clears slowly, leaving vision impaired for a long period. 

• Waiting 

Waiting is an option when bleeding ceases. In most cases, vitrectomy isn't necessary as the blood gradually clears to allow light to enter and pass through the eye again. Clearer vision will return after the vitreous clears if vision isn't damaged. 

General measures 

The specialist will see you immediately when a haemorrhage in the vitreous humour occurs because a sudden vision loss is an eye emergency. Immediate attention from the specialist increases the chance of arriving at the right diagnosis and prevents permanent vision loss, which may occur from retinal detachment. 

If a haemorrhage in the vitreous humour occurs, following advise is suggested. 

• Seek an urgent visit to eye specialist for urgent check up. 
• Try remaining calm, most causes of vitreous haemorrhage are treatable, and your vision will be restored.
• Rest for a couple of hours daily, sitting upright and elevate your head with pillows when sleeping (follow positioning suggested by your eye doctor).
• Avoid lifting heavy objects to prevent more bleeding.
• Optimise control of blood vessel disease like diabetes hypertension and smoking.

What is the prognosis of vitreous haemorrhage?

A prognosis for vitreous haemorrhage usually depends on the cause and severity of the condition. If a vitreous haemorrhage occurs due to vitreous detachment in the posterior side of the retina, the prognosis is usually good, and vision restoration is possible, especially if your vision is normal. 

If macular degeneration or eye disease resulting from diabetes causes abnormal vision, the prognosis is less good, and the prognosis may be poor if the cause is a penetrating eye injury. 

Prevention of vitreous haemorrhage

Preventing vitreous haemorrhage will require preventing the disease or condition's underlying cause. Possible preventive measures include regular and careful management of the eye disease resulting from diabetes, which may worsen in cases of uncontrolled diabetes. Quitting smoking and managing high blood pressure can also help prevent conditions leading to vitreous haemorrhage.  

When engaging in high-risk activities, playing sports and using a firearm, ensure you protect your eyes to prevent eye injury that may cause vitreous haemorrhage.  

If vitreous haemorrhage symptoms occur or you experience a sudden vision change, visit Optimal Vision to see an eye doctor. You can also call 020 7183 3725 to book an appointment and see a specialist.