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.

In vitreous haemorrhage, there is bleeding inside the vitreous gel (which is normally clear)
In vitreous haemorrhage, there is bleeding inside the vitreous gel (which is normally clear)

What causes vitreous haemorrhage?
Common causes/associations include:

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.

At the beginning of surgery, the vitreous is full of blood and there is no view of the retina.
At the beginning of surgery, the vitreous is full of blood and there is no view of the retina.
As Mr Shah uses the vitrector to clear the gel and its sequestered blood, the retina starts to come into view.
As Mr Shah uses the vitrector to clear the gel and its sequestered blood, the retina starts to come into view.
More of the peripheral gel and blood is removed, revealing extensive previous retinal laser treatment for diabetic retinopathy.
More of the peripheral gel and blood is removed, revealing extensive previous retinal laser treatment for diabetic retinopathy.
All of the peripheral gel and blood has been cleared. The yellow-white areas of retina are where the patient had previously received extensive panretinal laser treatment.
All of the peripheral gel and blood has been cleared. The yellow-white areas of retina are where the patient had previously received extensive panretinal laser treatment.
Now the central portion of gel and blood is removed.
Now the central portion of gel and blood is removed.
Here Mr Shah has identified the abnormal new vessels which were causing the bleed, and is applying diathermy to stop them from bleeding again after surgery.
Here Mr Shah has identified the abnormal new vessels which were causing the bleed, and is applying diathermy to stop them from bleeding again after surgery.
At the end of surgery, the vitreous gel has been removed, together with the blood it contained. A clear view of the retina is now possible and this patient's vision improved markedly following surgery.
At the end of surgery, the vitreous gel has been removed, together with the blood it contained. A clear view of the retina is now possible and this patient’s vision improved markedly following surgery.