What is vitreous hemorrhage?
The vitreous is the clear gel that fills most of the eye, between the lens in front and the retina in back. Normally there are no blood vessels in the vitreous itself — light passes through it cleanly to reach the retina. A vitreous hemorrhage occurs when blood leaks into the vitreous gel from elsewhere in the eye, usually from a damaged retinal blood vessel or a tear in the retina. Once blood is in the vitreous, it blocks light from reaching the retina, which is why vision becomes blurred or, in some cases, dramatically darker.
A vitreous hemorrhage is a sign that something else is happening inside the eye. The blood itself is not the disease — it is a symptom. Identifying the source of the bleeding is the most important part of the evaluation.
Symptoms
The most common symptoms are:
- A sudden shower of new floaters — sometimes described as a swarm of dots, cobwebs, or small specks
- A reddish or smoky tint to the vision
- Blurred vision, ranging from mild to severe
- In larger bleeds, the sensation of looking through dark fluid, or near-complete loss of vision in the affected eye
There is usually no pain. If you experience any sudden onset of floaters or vision changes, you should be evaluated promptly to rule out a retinal tear or detachment.
Common causes
A vitreous hemorrhage can come from a number of underlying conditions. The most common are:
- Retinal tear — when the vitreous pulls away from the retina with age (a posterior vitreous detachment), it can tear a small blood vessel along with the retina. This is one of the most common and most important causes to identify, because an associated retinal tear may need urgent treatment.
- Proliferative diabetic retinopathy — abnormal new blood vessels grown by the diabetic retina are fragile and can bleed.
- Retinal vein occlusion — areas of the retina that have lost blood flow can grow abnormal new vessels that bleed.
- Trauma — blunt or penetrating injury to the eye.
- Less common causes — including age-related macular degeneration, sickle cell retinopathy, and other vascular conditions.
How we diagnose it
A complete evaluation includes a careful dilated examination, often with scleral depression to inspect the peripheral retina. When the bleeding is dense enough that we cannot see through it to the retina, we use ocular ultrasound to look behind the blood and confirm whether there is a retinal tear or detachment underneath. Identifying the underlying cause guides everything that comes next.
Treatment options
Treatment depends on the cause and density of the bleeding. Many vitreous hemorrhages clear on their own and are simply monitored. When intervention is needed, options include laser or freezing in the office, intravitreal injections, or vitrectomy surgery to remove blood that is not clearing or to repair an underlying retinal tear or detachment.