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Review
. 2023 Jan;71(1):28-38.
doi: 10.4103/ijo.IJO_928_22.

Vitreous hemorrhage - Causes, diagnosis, and management

Nawazish Shaikh  1 , Ramamurthy Srishti  2 , Aayesha Khanum  3 , M B Thirumalesh  3 , Vivek Dave  2 , Atul Arora  4 , Reema Bansal  1 , Abhidnya Surve  1 , Shoryavardhan Azad  1 , Vinod Kumar  1
Affiliations
Review

Vitreous hemorrhage - Causes, diagnosis, and management

Nawazish Shaikh et al. Indian J Ophthalmol. 2023 Jan.

Abstract

Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Keywords: Diabetic retinopathy; Terson's syndrome; laser photo-coagulation; proliferative retinopathy; valsalva retinopathy; vascular occlusion; vitrectomy; vitreous hemorrhage.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Diagramatic representation of the structure of vitreous humor
Figure 2
Figure 2
Schematic representation of anatomy of vitreous humor
Figure 3
Figure 3
Ultra-widefield fundus photograph (Optos California) of a patient with diabetic vitreous hemorrhage (Panel b). Fundus examination of the fellow eye shows proliferative diabetic retinopathy giving a clue toward etiology of vitreous hemorrhage (Panel a)
Figure 4
Figure 4
Vitreous hemorrhage with neo-vacularization of disc (NVD) in a patient with occlusive vasculitis
Figure 5
Figure 5
Ultra-widefield fundus photograph (Optos California) of a patient with diabetic vitreous hemorrhage along with asteroid hyalosis (Panel a). Fundus examination of the fellow eye shows non-proliferative diabetic retinopathy giving a clue toward etiology of vitreous hemorrhage likely because of vascular occlusion (Panel b)
Figure 6
Figure 6
Vitreous hemorrhage in a patient with intra-cranial bleed (Terson’s syndrome)
Figure 7
Figure 7
Cross-sectional B-scan image with overlying A-scan of the eye showing tractional retinal detachment with associated sub-hyaloid hemorrhage (Panel a, Blue arrow), sub-hyaloid hemorrhage (Panel b, Red arrow), vitreous hemorrhage associated with retinal detachment seen as a double membrane (Panel c, Yellow arrow), and dispersed rebleed in the vitrectomized eye (Panel d, Green arrow)
Figure 8
Figure 8
Fluorescein angiography showing laser marks in a patient with proliferative diabetic retinopathy (Panel a) and vascular occlusion (Panel b)
See this image and copyright information in PMC

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