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Clinical Summary

Patients may complain of floaters followed by the sudden loss or deterioration of vision in the affected eye, although bilateral hemorrhage can occur. The red reflex is diminished or absent, and the retina is obscured because of the bleeding. Large sheets or three-dimensional collections of red to red-black blood may be detected.

Multiple underlying etiologies include proliferative diabetic retinopathy, retinal or vitreous detachments, hematologic diseases, trauma (ocular or shaken impact syndrome), subarachnoid hemorrhage (SAH), collagen vascular disease, infections, macular degeneration, and tumors.

FIGURE 3.20

Vitreous Hemorrhage. Large amount of vitreous hemorrhage associated with metallic intraocular foreign body. The large quantity of blood obscures visualization of retinal details. (Photo contributor: Richard E. Wyszynski, MD.)

Management and Disposition

Refer to an ophthalmologist and an appropriate physician for associated conditions. Ophthalmic observation, photocoagulation, and surgery are all therapeutic options. Bed rest may help to increase visualization of the fundus.

Pearl

  1. The patient’s vision may improve somewhat after a period of sitting or standing as the blood layers out.

FIGURE 3.21

Vitreous Hemorrhage. A smaller amount of vitreous hemorrhage is more easily photographed. Gravitational effect on the vitreous blood creates the appearance of a flat meniscus (keel-shaped blood) in this patient with vitreous hemorrhage associated with proliferative diabetic retinopathy. (Photo contributor: Richard E. Wyszynski, MD.)

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