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Vitreous Haemorrhage | Causes and Treatment

Publisher/Author : Pacific Cross

Vitreous haemorrhage occurs when blood leaks into the vitreous humour inside the eye. The blood most commonly comes from blood vessels at the back of the eye. These can be either of the following:

Normal blood vessels which have been damaged. Fragile abnormal blood vessels which have grown at the back of the eye and which bleed very easily.

In order for us to see clearly, the vitreous humour needs to be clear. If the vitreous humour is clouded or filled with blood, vision will be impaired. This varies from a few ‘floaters’ and cloudiness of the vision through to the vision going completely dark (sometimes with a reddish tinge).

Vitreous haemorrhage affects about 7 per 100,000 people each year. This makes it one of the most common causes of sudden deterioration in vision. It most often affects only one eye. Please discuss with your doctor for further information.

What is Vitreous Degeneration?

Vitreous is the gel-like substance that fills the inside of the eye behind the lens. Before you were born, it helped maintain the shape of the eye and nourish the

eye as it developed. When you were younger, the vitreous gel filled the eyeball like Jell-O. The vitreous also contains fibers that attach to the surface of the retina (see image on the right). Over time, the vitreous begins to liquefy and shrink. Then the fibers can pull on the retina. Vitreous degeneration results in floaters. Floaters are seen as small moving dots or wispy gray spots or lines. The final stage of vitreous degeneration occurs when the vitreous completely separates from the retina. This is known as a posterior vitreous detachment.

Vitreous Degeneration is a common condition. It’s most commonly seen in adults over the age of 50, though younger people can also have vitreous degeneration. Please discuss with your doctor for further information.

What are the symptoms of disorders of vitreous body?

The common symptoms of Vitreous Degeneration are:

  • Floaters appear in eye causing spots, strings cobwebs shadows in vision. As time passes either they disappear themselves or settle down at the bottom of the eye.
  • Initially, it may be annoying as shadows in vision appear, but after sometime brain learns to ignore it. Blinking of eyes or head movement relieves the condition.
  • Increase in the numbers of floaters along with flashes of light and peripheral vision is disturbed in progressive stage of the disease.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

The common symptoms of Vitreous Haemorrhage are:

  • Painless floaters within your vision, often described as lines, spider-webs, or many dark spots
  • Painless floaters within your vision
  • Hazy vision
  • Blind spots
  • Dark streaks
  • Complete vision loss

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

What causes disorders of vitreous body?

Vitreous Haemorrhage

Abnormal blood vessels

Usually the result of neovascularization, in which there is a natural formation of new blood vessels that develop in response to local poor blood perfusion or ischemia. The most common cause of neovascularization due to ischemia includes diabetic retinopathy, sickle cell retinopathy, retinal vein occlusion, retinopathy of prematurity, or ocular ischemic syndrome.

It is because these newly formed blood vessels lack endothelial tight junctions that they are predisposed to spontaneous bleeding, essentially being fragile blood vessels.

Rupture of normal blood vessels

Often to sufficient mechanical force that overcomes the structural integrity of the blood vessel. Cases such as posterior vitreous detachment may compromise a blood vessel, leading to vitreous hemorrhage.

Other causes may be due to blunt or perforating trauma injuring intact blood vessels directly. This is a common occurrence in people younger than 40 years of age, directly leading to vitreous hemorrhage.

A rare cause of vitreous hemorrhage due to the rupture of normal vessels is Terson’s syndrome, caused by subarachnoid hemorrhage. This condition is caused by increased intracranial pressure leading to rupture of the retinal venules.

Blood from an adjacent source

Bleeding from retinal macro-aneurysms, tumors, and choroidal neovascularization can all extend through the internal limiting membrane and into the vitreous humor.

Vitreous degeneration

The most common cause of vitreous degeneration is advancing age. Some risk factors may quicken the onset of this eye condition.

What increases my risk for disorders of vitreous body?

There are many risk factors for Vitreous Degeneration, such as:

  • Eye trauma or any inflammation in eyes may quicken the formation of floaters.

  • Myopia or nearsightedness. Patients of myopia may experience these degenerative changes at an early age.

  • Cataract surgery or previously done any laser treatment or surgery of eye may also increase the risk of formation of floaters in some people.

The common causes of vitreous haemorrhage tend to occur in adults aged 60 and above, except for eye trauma, which can occur at any age.

Diagnosis & treatment

How is disorders of vitreous diagnosed?

Diagnosis of vitreous degeneration depends on the stages of this disease. A comprehensive dilated full eye examination is required in the advanced stages of the disorder.

After a doctor takes your medical history and a physical consisting of an eye inspection, the most useful test for the diagnosis of vitreous hemorrhage is a device called a slit lamp. This test allows doctors to look for the presence of blood in the vitreous humor. Depending on the amount of blood leakage into the vitreous, it may also be possible to identify the source of the bleeding with a slit lamp.

In cases where the amount of blood in the vitreous humor prevents adequate identification of the bleeding source, an ultrasound scan of the eye can be used. Ultrasounds can detect many causes of vitreous hemorrhage, including posterior vitreous detachment, retinal tears and detachments, tumors, and foreign bodies.

Other possible tests include a computed tomography (CT) scan in cases of penetrating injury and an angiogram to show the blood vessels in the back of the eye.

How is disorders of vitreous treated?

Benign form having few floaters need no treatment as possess no threat to the vision. As time passes and the floaters settle down at the bottom of eye by itself.

Floaters may last for weeks to months to years. Few cases have been reported where they did not disappear completely. Even then floaters are not accompanied by any vision problem.

Therefore no active treatment is required to remove it. Though persistent floaters may annoying effect patient are advised to learn to avoid it since no measure is there to prevent the formation of these floaters.

Progressed state of vitreous degeneration when sudden increase in floaters are observed along with flashes of light in peripheral vision, need full eye examination.

Patients are advised not to avoid this situation and immediately undergo full eye examination by an expert. Since leaving macular hole or retinal detachment condition untreated, may lead to severe vision problems or permanent loss of vision.

Nearsighted patients need much care since chances of retinal detachment are more common among myopic patients. Treatment of vitreous degeneration in such cases is aimed at reducing floaters and other symptoms and improving the vision problems.

Tear of retina, if detected early, may be treated with the Laser therapy but if condition progresses to retinal detachment surgery is required. There is no simple therapy to remove floaters other than surgery.

Surgery is preferred in severe and serious forms like detachment as they too have the risk of complications and side effects.

The treatment of vitreous degeneration based on various stages includes:

  • Floater: Need no treatment
  • Sudden Increase In Floater: Full eye examination is required. Treatment then depends on severity.
  • Floaters with Flashes of Light: Comprehensive dilated eye examination should be done by expert. If it suggests early retinal tear, Laser therapy may be beneficial
  • Retinal Detachment: Surgery – Vitrectomy is advised.
  • Vitrectomy is the surgery for vitreous degeneration, done to remove the vitreous gel. It is performed by an ophthalmologist who has been trained to intra ocular surgeries.

If there is retinal detachment or blood due to vitreous hemorrhage in vitreous gel that does not clear on its own, vitrectomy is performed. Local or general anesthesia is preferred according to the condition of patient. Vitreous gel is removed from middle of eye using special tools and then repair to the retinal scar, tear or detachment is done. Further, gas bubble or oil bubble is injected inside the eye to press the retinal wall to its original position.

Ultimately, the underlying cause of the vitreous hemorrhage will determine the most appropriate treatment required. Regardless of which kind of treatment is implemented, they all aim to find the source of the blood, put a stop to it, repair any damage to the retina before any resulting vision loss, and restore normal vision.

Additionally, vitreous hemorrhage patients are advised to avoid strenuous activity for several days after treatment as this may dislodge clots and trigger a new bleed. Sleeping with the head of the bed elevated will also allow for the blood in the vitreous humor to settle into the bottom of the eye, reducing the chances of it obstructing vision.

If there are excessive amounts of blood obscuring the ability to find the source of bleeding and preventing treatment, your doctor may suggest a vitrectomy, which involves the removal of the entire vitreous to get a better view of the back of the eye.

The following are specific treatments used for vitreous hemorrhage:

  • Laser photocoagulation: Used for repairing damage to the retina and retinal detachments. Lasers are used to both stops bleeding and prevent future bleeds.
  • Anti-VEGF injections: Sometimes used in diabetic patients in addition to other treatments such as laser photocoagulation and vitrectomy. It aims to shrink abnormal blood vessels that have formed in the eye.
  • Cryotherapy: Used to treat retinal tears and retinal detachments. While it is unclear exactly how this treatment method works, it is believed that it causes the breakdown of the blood-retinal barrier, which in turn leads to the clearance of liquified blood.
  • Waiting: Giving enough time after the bleeding has stopped can be all that is needed in some cases. Blood can slowly clear from the vitreous over time, allowing light to pass through and vision to be restored, granted there is no damage to the retina beforehand.

What are some lifestyle changes or home remedies that can help me manage disorders of vitreous?

The following lifestyles and home remedies might help you cope with disorders of vitreous:

  • Careful and regular management of diabetic eye disease and high blood pressure
  • Quitting smoking
  • Protecting your eyes from any potential trauma

If you have any questions, please consult with your doctor to better understand the best solution for you. Hello Health Group does not provide medical advice, diagnosis or treatment.

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