The vitreous humor is a jelly-like, clear avascular liquid that fills up to two thirds of the eyeball total space. It has a volume of approximately 4 ml in adults.The vitreous humor is 99 percent water, and the remaining 1 percent is made up of collagen and hyaluronic acid.
In most of the cases, vitreous hemorrhage doesn’t happen due to direct hemorrhage inside the vitreous, which is an avascular tissue, but rather as a result of hemorrhage of the retinal vessels or vascular layer underneath (choroid). Sometimes bleeding inside the iris can also lead to intravitreal hemorrhage.
This bleeding is usually seen in people over the age of 50 but may occur at any age.
Vitreous Hemorrhage Symptoms
1. Sudden blurry vision
4. Sudden blindness
Vitreous Hemorrhage Causes
This problem may occur because of different reasons, but the most common causes of vitreous hemorrhage include:
1. Proliferative Diabetic Retinopathy is the most common cause of spontaneous vitreous hemorrhage. In diabetes, new vessels develop in the eye. These vessels are fragile and susceptible to bleeding.
2. Retinal detachment and retinal tear can also cause vitreous hemorrhage, as it blocks the veins that feed the retina, which may then bleed into the vitreous gel.
3. Posterior detachment of the vitreous (vitreous detachment from the retina), which is common during and after mid-life, can cause the rupture of one of the retinal blood vessels and thereby lead to bleeding within the vitreous.
4. Blockage of the retinal central venous or its branches can lead to vitreous hemorrhage, especially in patients with diabetes or high blood pressure.
5. Eye traumas such as Shaken Baby Syndrome
Vitreous Hemorrhage Diagnosis
It is necessary to examine both eyes, because examining the healthy eye may help the physician to discover the cause.
1. Visual Acuity Measurement
2. Testing pupil response to light
3. Slit-lamp examination
4. Direct and indirect examination of the bottom of the eye
Laboratory Diagnostic Procedures:
There are no specific tests to diagnose this condition. When fundus examination is not feasible due to hemorrhage or corneal opacity or cataract, ultrasound examination is required.
Vitreous Hemorrhage Treatment
1. Examination is required by a retina specialist.
2. The treatment of intra-vitreous hemorrhage depends on its constitutive cause. In retinal detachment or retina tear, a laser or cryotherapy surgery is required. In presence of underlying illness, it is necessary to provide maintenance treatments and care for the patient, such as sleeping in a semi-sitting position for the patient until the blood is absorbed.
3. Except for cases that hemorrhage is the result of trauma or retinal detachment, careful follow up for 1 to 2 weeks can lead to some bleeding absorption, but the return of vision may take several months. Surgical intervention using Pars Plana's vitrectomy can improve vision on the condition that macular is healthy.
4. Two-sided dressing which limits eye movement is helpful and also the patients should be recommended to sit with their heads straight to accelerate the healing process.
5. There are new methods, such as fluidclotting or hemolysis (with ultrasound or immune globulin anti-Rh) or phagocytosis by using intracellular interleukin-1( intravenous), which are predominantly in the research process and whose efficacy has not yet been proven.
It depends on the underlying cause. The prognosis of intravitreal hemorrhage is poor in diabetic patients or those with age- related retinal changes. In cases where intra-vitreous hemorrhage has occurred due to retinal breakage, early intervention can improve prognosis and, if treatment is delayed, there will be no satisfying prognosis.
An Important Note: Vitreous hemorrhage is always the sign of a serious disease, so it should always be treated as soon as possible.
Retinal Detachment Brochure