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Book

Vitreous Hemorrhage

Soumya Jena  1 , Koushik Tripathy  2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
.
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Book

Vitreous Hemorrhage

Soumya Jena et al.
Free Books & Documents

Excerpt

The vitreous humor is a transparent, colorless, jelly-like, hydrophilic gel, which helps in maintaining the transparency and structure of the eye. Its volume in an adult eye is around 4ml, which is nearly 80% of the globe. It is composed of 98 to 99% water, and the rest is collagen, hyaluronic acid, and electrolytes.

Any blood in the vitreous cavity is known as vitreous hemorrhage (VH). By definition, it is the presence of extravasated blood within a space lined by posterior lens capsule anteriorly, internal limiting membrane (ILM) posteriorly, and non-pigmented epithelium of ciliary body laterally.

Anatomically, it can be present in the following spaces:

  1. Preretinal

    1. Subhyaloid hemorrhage - The blood may lie between nondetached hyaloid and ILM. It occurs in a boat shape and is usually immobile. It is usually seen in proliferative diabetic retinopathy (PDR). The hemorrhage may occupy the space between extensively detached hyaloid and ILM also. It contains altered blood and can shift with the position.

    2. Sub-ILM hemorrhage - The hemorrhage lies between the nerve fiber layer of the retina and ILM. As clinical differentiation of sub-ILM hemorrhage and subhyaloid hemorrhage may not be possible in some cases, sub-ILM bleeding is also considered to be a type of vitreous hemorrhage. Sub-ILM hemorrhage has a boat-shaped appearance with a horizontal upper level. It does not shift with the position. It is seen in Terson syndrome, retinal macroaneurysm (RAM), and Valsalva retinopathy.

  2. Intravitreal or intragel

    1. The blood is dispersed in the gel. It can settle down due to gravity and clots rapidly. The color of the blood may vary from red to yellow, depending on the extent of the degeneration of red blood cells (RBCs).

There are spaces filled with aqueous humor that lies anterior to the border of formed vitreous.

  1. The canal of Hannover lies between orbiculo-anterocapsular and orbiculo-posterocapsular parts of zonular fibers.

  2. Berger's canal (retrolental space of Erggelet) and canal of Petit are located between the anterior hyaloid membrane and posterior capsular surface and orbiculo-posterocapsular part of zonular fibers. They are separated from each other by Wieger's ligament.

  3. Cloquet's canal and bursa premacularis are fluid-filled spaces within formed vitreous.

Hemorrhage into Berger's space, the canal of Petit, and Cloquet's canal have also been included in vitreous hemorrhage.

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Conflict of interest statement

Disclosure: Soumya Jena declares no relevant financial relationships with ineligible companies.

Disclosure: Koushik Tripathy declares no relevant financial relationships with ineligible companies.

References

    1. Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997 Jul-Aug;42(1):3-39. - PubMed
    1. Dana MR, Werner MS, Viana MA, Shapiro MJ. Spontaneous and traumatic vitreous hemorrhage. Ophthalmology. 1993 Sep;100(9):1377-83. - PubMed
    1. Tripathy K. Dissociated optic nerve fiber layer in a case of Terson syndrome. Eur J Ophthalmol. 2020 Sep;30(5):NP11-NP14. - PubMed
    1. Czorlich P, Skevas C, Knospe V, Vettorazzi E, Richard G, Wagenfeld L, Westphal M, Regelsberger J. Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury. Neurosurg Rev. 2015 Jan;38(1):129-36; discussion 136. - PubMed
    1. Srinivasan S, Kyle G. Subinternal limiting membrane and subhyaloid haemorrhage in Terson syndrome: the macular 'double ring' sign. Eye (Lond) 2006 Sep;20(9):1099-101. - PubMed

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