What is Vitreous Hemorrhage? Causes, Symptoms, and Treatment Options
- sakai208
- Dec 18, 2025
- 3 min read
I. Introduction: What is Vitreous Hemorrhage?
The interior of the eye is not an empty space; it is filled with a clear, jelly-like substance called the vitreous humor. In a healthy eye, this medium is transparent, allowing light to pass through to the retina to form an image. Vitreous Hemorrhage occurs when blood leaks into this cavity.
When blood enters the vitreous, it scatters and blocks incoming light. Depending on the volume of the leakage, the impact can range from mild "floaters" to a complete loss of functional vision. While the hemorrhage itself is often a symptom of another condition, it is a clinical emergency that requires immediate evaluation to protect the delicate tissues of the retina.
II. Signs and Symptoms
The onset of vitreous hemorrhage is typically sudden and painless. Patients often report the following:
Floaters: The sudden appearance of black spots, cobwebs, streaks, or "dust" in the field of vision.
Smoky or Cloudy Vision: A sensation of looking through a dark mist or thick smoke.
Significant Vision Loss: If the hemorrhage is dense, the patient may only be able to perceive light or hand motions.
Because there are no pain receptors in the vitreous, the condition is usually physically comfortable, which can unfortunately lead some patients to delay seeking care.
III. Common Causes and Risk Factors
A vitreous hemorrhage happens when a blood vessel in the eye ruptures. This is usually caused by one of three mechanisms:
Abnormal Vessel Growth: In conditions like Proliferative Diabetic Retinopathy (PDR), the eye grows fragile new vessels that bleed easily.
Mechanical Trauma: A retinal tear can rip a healthy blood vessel as the retina pulls away.
Vascular Blockage: A retinal vein occlusion can cause pressure to build up, leading to a blowout of the vessel wall.
IV. Diagnostic Procedures
When a patient presents with a clouded eye, the specialist must determine what is happening behind the blood.
Dilated Eye Exam: If the blood is thin, the doctor can see the retina directly.
B-Scan Ultrasound: If the blood is too dense for light to pass through, ultrasound becomes the "gold standard." It uses sound waves to "see" if the retina is still attached or if a tear is present.
V. Management and Treatment Pathways
Not every hemorrhage requires surgery. The treatment path depends on the cause:
Observation: If the retina is safe, the doctor may recommend waiting for the blood to settle or be reabsorbed naturally.
Positional Therapy: Patients are often told to sleep with their head elevated to allow gravity to pull the blood down, clearing the visual axis.
Anti-VEGF Injections: Medications can be injected to shrink abnormal, leaking vessels.
Surgery: See details bellow.
VI. Surgical Intervention: Vitrectomy
If the blood does not clear on its own, or if there is a retinal detachment, a surgery called Pars Plana Vitrectomy (PPV) is performed.
The Procedure: The surgeon removes the blood-stained vitreous and replaces it with a clear saline solution, gas, or oil.
Expectations: Patients often have questions regarding the duration, cost, and recovery process associated with vitreous hemorrhage surgery.
VII. Prognosis: Is it Curable?
The question of whether the condition is curable depends on the health of the underlying retina. If the retina remains attached and the underlying cause (like diabetes) is managed, the prognosis for vision recovery is generally good. However, preventing recurrence requires strict control of systemic health, such as blood sugar and blood pressure.
VIII. Conclusion: The Importance of Timely Evaluation
Vitreous hemorrhage is a dramatic event that serves as a warning sign for the eye. Whether it is a minor leak or a major blockage, the goal is always the same: clear the visual field and protect the retina. Early diagnostic imaging, particularly ultrasound, is the key to ensuring that a temporary hemorrhage doesn't lead to permanent vision loss.
This article was reviewed by
Dr. Daiki Sakai, MD
