Vitreous Hemorrhage

Vitreous Hemorrhage
SYMPTOMS Sudden loss of vision, Blurry vision, Floaters, Flashes
SIGNS Hazy retinal views, Obscuration of underlying retina, Blood in the vitreous
Preretinal: Blood found between the ILM and NFL. Has a "keel-boat" shaped appearance if found along the inferior retina and a more linear shaped appearance if found along the superior retina
Subhyaloid: Blood found between the posterior hyaloid face of the vitreous and ILM. Has a "keel-boat" shaped appearance if found along the inferior retina and a more linear shaped appearance if found along the superior retina
Intravitreal: Blood found within the vitreous body
WORK-UP Slit lamp examination, Dilated retinal exam, Scleral depression (especially if suspecting a retinal hole, retinal tear, or retinal detachment), B-scan ultrasound (if unable to view the retina), OCT, OCT-Angiography
TREATMENT Refer to retinal specialist ASAP for treatment of underlying cause
FOLLOW-UP Once vitreous hemorrhage as well as underlying etiology is treated and resolved or stable, the patient should be monitored every 4-6 months
ADDITIONAL LAB | TESTS Lab testing to consider ordering especially if etiology of vitreous hemorrhage is not associated with a retinal break, retinal detachment, or ocular trauma: 1. Blood pressure evaluation 2. Fasting blood sugar 3. HbA1c 4. PT,TT,BT,PTT,INR (to rule out blood coagulopathies) 5. CBC with differential
ETIOLOGY Leakage of blood into the superficial retina, between the retina and vitreous, and vitreous cavity due to mechanical force or retina/choroid pathology
DIFFERENTIAL DX Asteroid hyalosis, Vitreous syneresis, Vitritis, Posterior vitreous detachment
NOTES The three most common causes of a vitreous hemorrhage are proliferative diabetic retinopathy, posterior vitreous detachment, and ocular trauma
Blood in the vitreous will turn yellow to white (due to red blood cell dehemoglobinization) and sink inferiorly
Vitreous Hemorrhage: B-scan ultrasound of an intravitreal hemorrhage https://www.researchgate.net/figure/B-scan-image-of-vitreous-hemorrhage-without-retinal-detachment_fig1_288701207