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Viterous Hemmorage

This document discusses vitreous hemorrhage, which occurs when blood leaks into the gel-like vitreous humor located in the middle of the eye. Vitreous hemorrhage can be caused by conditions that rupture blood vessels in the eye like retinal tears, trauma, inflammation, and vascular or metabolic disorders like diabetes. Symptoms include floaters or sudden vision loss. Signs include observing blood in the vitreous cavity during examination. Treatment may include resting the eye, treating the underlying cause, or vitrectomy surgery to clear blood from the vitreous if it does not absorb on its own after 3 months.

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Kishan S Gowda
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86 views11 pages

Viterous Hemmorage

This document discusses vitreous hemorrhage, which occurs when blood leaks into the gel-like vitreous humor located in the middle of the eye. Vitreous hemorrhage can be caused by conditions that rupture blood vessels in the eye like retinal tears, trauma, inflammation, and vascular or metabolic disorders like diabetes. Symptoms include floaters or sudden vision loss. Signs include observing blood in the vitreous cavity during examination. Treatment may include resting the eye, treating the underlying cause, or vitrectomy surgery to clear blood from the vitreous if it does not absorb on its own after 3 months.

Uploaded by

Kishan S Gowda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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VITREOUS HEMORRHAGE 

MADAN SN 
53
VITREOUS HAEMORRHAGE                       
        

 Vitreous  haemorrhage usually occurs from the retinal vessels and may


present as pre retinal(sub-hyaloid) or an intragel  haemorrhage.
The intragel  hemorrhage may involve anterior, middle, posterior or the
whole vitreous body 
Causes 
1. Retinal tear, PVD and RD may have associated vitreous haemorrhage                  
2. Trauma to eye, which may be blunc or perforating (with or without   retanied intraocular
foreign body) in nature                                                              
3. Inflammatory diseases such as erosion of the vessels in acute chorioretinitis and
periphlebitis retinae primary (Eales' disease), or secondary to uveitis                          
4. Vascular disorders, e.g. hypertensive retinopathy, cenrral retinal vein occlusion (CRVO)
and, branch retinal vein occlusion (BRVO).                                                       
5. Metabolic diseases such as diabetic retinopathy.
.

6. Exudative age-related macular degeneration usually high CNVM, may have vitreous
haemorrhage                                                                                                  
7.Blood dyscrasias, e.g. retinopathy of anaemia, leukaemias, polycythemias and sickle-cell
retinopathy.                                                                                                 
8. Bleeding disorders, e.g. purpura, haemophilia and scurvy.                                     
9. Neoplasms. Vitreous haemorrhage may occur from rupture of vessels due to acute necrosis in
tumours like retinoblastoma and malignant melanoma of choroid.  
10. Other causes include Coat's diseases, radiation retinopathy, retinal capillary aneurysm,
retinal macroaneurysm terson syndrome.
Clinical features
Depending upon the location it is labeled as:                                                                 
• Anterior vitreous haemorrhage,                                                                               
• Mid vitreous haemorrhage,                                                                                     
• Posterior vitreous haemorrhage, or                                                                        
• Total vitreous haemorrhage
Symptoms
• Floaters of sudden onset occur when the vitreous haemorrhage is small               
• Sudden painless loss of vision occurs in large vitreous haemorrhage. 
Signs
• Distant direct ophthalmoscopy reveals black shadows against the red glow in small
haemorrhages and no red glow in a large haemorrhage.                                   
• Direct and indirect ophthalmoscopy may show presence of blood in the vitreous cavity in
small  vitreous haemorrhage and non-visualization of fundus in large  vitreous haemorrhage.       
                                       
• Slit-lamp examination shows normal anterior segment and a reddish mass in the vitreous.       
                                                         
• Ultrasonography with B-scan is particularly helpful in diagnosing vitreous haemorrhage.
Fate of vitreous haemorrhage
 l. Complete absorption may occur without organization and the vitreous becomes clear within
4-8 weeks.                                                                                               
2. Organization of haemorrhage with formation of a yellowish-white debris occurs in persistent
or recurrent bleeding.                                                                               
3. Complications like vitreous liquefaction, degeneration and khaki cell glaucoma (in aphakia)
may occur.                                                                                                 
 4. Retinitis proliferans may occur which may be complicated by tractional retinal detachment. 
Treatment 
I. Conservative treatment consists of bed rest and elevation of patient's head. This will allow
the blood to settle down. Most of the time conservative treatment is sufficient. 

II. Treatment of the cause. Once the blood settles down, indirect ophthalmoscopy should be
performed to locate and further manage the causative lesion such as a retinal break,
phlebitis, proliferative retinopathy, etc.                                                  
III.  Vitrectomy by pars plana route should be considered to clear the vitreous, if the
haemorrhage is not absorbed after 3 months. Early vitrectomy may be required when
associated with retinal detachment. 
Reference

Comprehensive opthalmology, A K Khurana


.

THANK YOU

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