Medical Care

Treatment of vitreous hemorrhage is directed at the underlying cause, if known.

On rare occasions, such as unreliable/noncompliant patients with vitreous hemorrhage complicated with severe hyphema, patients may be admitted to the hospital for close observation. Otherwise, most patients are monitored closely on an outpatient basis with emphasis on cooperation with treatment instructions.

Bed rest with the head of the bed elevated 30-45° with occasional bilateral patching to allow the blood to settle inferiorly, allowing a view of the superior peripheral fundus

Avoid drugs such as aspirin and other anticlotting agents when necessary.

Surgical Care

The goal of vitreous hemorrhage management is to treat the underlying cause as quickly as possible. For example, retinal breaks are closed by laser photocoagulation or cryotherapy (unlike cryotherapy, laser photocoagulation can close the compromised vessel in addition to the retinal tear); detached retinas are reattached with surgery; and proliferative retinal vascular diseases are treated with laser photocoagulation or cryotherapy (when there is no view of the retina).

Indications for surgical removal of the vitreous blood include the following:

Vitreous hemorrhage associated with detached retina
Long-standing vitreous hemorrhage with duration greater than 2-3 months (Vitrectomy for isolated vitreous hemorrhage (eg, without retinal detachment) may be performed before 2-3 months in patients with juvenile-onset diabetes, patients with bilateral vitreous hemorrhage, children in the amblyogenic age range, and/or when retinal traction is suspected.)^[3]
Vitreous hemorrhage associated with rubeosis
Vitreous hemorrhage associated with hemolytic or ghost-cell glaucoma

Consultations

Consultations depend on the suspected underlying etiology and most likely differential diagnoses. See Differentials.

Retinal specialist

Prevention

A study by Smith and Steel has shown a certain amount of evidence to support that using antivascular endothelial growth factor preoperatively in diabetic vitrectomy can lower the occurrence of early postoperative vitreous cavity hemorrhage.^[4]

Further Outpatient Care

Initially, patients with vitreous hemorrhage are monitored daily for 2-5 days to rule out retinal tear or detachment, then every 1-2 weeks for spontaneous clearing. However, in the event that the dense vitreous hemorrhage persists without known underlying cause, a B-scan ultrasonography should be serially performed.

Medication

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Author

Brian A Phillpotts, MD Ophthalmologist, St Luke's Cataract and Laser Institute

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Douglas R Lazzaro, MD, FAAO, FACS Chairman, Professor of Ophthalmology, The Richard C Troutman, MD, Distinguished Chair in Ophthalmology and Ophthalmic Microsurgery, Department of Ophthalmology, State University of New York Downstate Medical Center; Chief of Ophthalmology, Director of Cornea, Director of Surgical Training, Kings County Hospital Center

Douglas R Lazzaro, MD, FAAO, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology, Brooklyn Ophthalmological Society, Cornea Society, New York Society for Clinical Ophthalmology, Ophthalmic Laser Surgical Society

Disclosure: Nothing to disclose.

Additional Contributors

V Al Pakalnis, MD, PhD Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Jon P Gieser, MD Assistant Professor, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago

Jon P Gieser, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and American Medical Association

Disclosure: Nothing to disclose.