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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.
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.
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.
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.
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.
Common causes of vitreous haemorrhage, accounting for up to 90% of this condition, include:
Bleeding in the eye often occurs from:
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.
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.
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.
Treatment for vitreous haemorrhage differs depending on the cause. The treatments usually aim for the following:
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.
Common specific treatments include:
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.
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.
It may be necessary for treating retinal detachments and tears in periphery of your retina.
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 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.
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.
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.
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.
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