Patients with vitreous hemorrhage complain of sudden visual loss, abrupt onset of floaters that may progressively increase in severity, or occasionally, “bleeding within the eye.” Visual acuity ranges from 20/20 (6/6) to light perception. The eye is not inflamed, red, or painful, and clues to diagnosis are inability to see fundus details or localized collection of blood in the vitreous, in front of the retina (eFigure 7–40). Causes of vitreous hemorrhage include retinal tear (with or without detachment), diabetic or sickle cell retinopathy, retinal vein occlusion, retinal vasculitis, neovascular age-related macular degeneration, retinal arterial macroaneurysm, blood dyscrasia, therapeutic anticoagulation, trauma, subarachnoid hemorrhage, and severe straining (Valsalva retinopathy).
Large preretinal hemorrhage. (Reproduced, with permission, from Riordan-Eva P, Augsburger JJ. Vaughan & Asbury’s General Ophthalmology, 19th ed. McGraw-Hill, 2018.)
All patients with suspected vitreous hemorrhage must be referred urgently to an ophthalmologist to determine the etiology. If the vitreous hemorrhage is caused by a retinal tear or detachment, it must be repaired urgently to prevent permanent vision loss.
et al. A comparison of immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging Retina. 2016 Jan;47(1):35–41.
et al. Acute-onset vitreous hemorrhage of unknown origin before vitrectomy: causes and prognosis. J Ophthalmol. 2015;2015:429251.
et al. Ophthalmic complications associated with direct oral anticoagulant medications. Semin Ophthalmol. 2017;32(5):614–9.
et al. Early vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy. J Int Med Res. 2017 Dec;45(6):2065–71.