What is vitreous haemorrhage?
This is a bleed inside the vitreous humour, which is the normally clear gel-like substance that fills up the main cavity of the eye.
What causes vitreous haemorrhage?
Common causes/associations include:
- Advanced (proliferative) diabetic eye disease
- Retinal vein occlusion
- Posterior vitreous detachment and/or retinal detachment
- Eye injuries
- Wet macular degeneration
- Eccentric choroidal neovascularisation (similar to wet macular degeneration, but affecting the peripheral retina instead of the macula)
What are the symptoms of vitreous haemorrhage?
Most patients will experience floaters and/or blurring of vision, which can vary – depending on the extent of the bleed – from very mild to almost complete loss of vision.
What are the complications of vitreous haemorrhage?
The major consideration is that as well as reducing the patient’s vision, vitreous haemorrhage often obscures the view of the retina that an eye specialist can obtain. This means in cases of marked vitreous haemorrhage, it is difficult to verify the health or integrity of the retina. B-mode ultrasound can be used to verify that there is no retinal detachment, but detailed assessment of the retina’s health is often impossible unless a clear view is obtained.
In longstanding untreated vitreous haemorrhage, the red blood cells in the eye can eventually clog up the drainage angle of the eye, causing the eye pressure to rise, sometimes leading to optic nerve dysfunction – this is called ghost cell glaucoma, which is a form of secondary glaucoma. If this happens, it may be a reason to proceed to vitrectomy surgery.
How is vitreous haemorrhage treated?
In mild cases where an adequate view of the retina is still possible, observation only may be appropriate, as the haemorrhage can eventually clear up on its own. In more marked cases, or where the visual symptoms (floaters and/or blurred vision) are significantly bothersome, the only treatment option for vitreous haemorrhage is to clear it from the eye with an operation known as vitrectomy. Below are images taken from a vitrectomy operation performed by Mr Shah to clear vitreous haemorrhage from an eye with advanced diabetic retinopathy.