eMedicine Specialties > Ophthalmology > Vitreous

Hemorrhage, Vitreous: Differential Diagnoses & Workup

Author: Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Coauthor(s): Norman P Blair, MD, Director, Vitreoretinal Division, Laboratory of Retinal Circulation and Metabolism, Illinois Eye and Ear Infirmary; Professor, Department of Ophthalmology, University of Illinois at Chicago; Jon P Gieser, MD, Assistant Professor, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Feb 13, 2007

Differential Diagnoses

ARMD, Exudative
Ocular Manifestations of Syphilis
Branch Retinal Artery Occlusion
Presumed Ocular Histoplasmosis Syndrome
Branch Retinal Vein Occlusion
Retinitis Pigmentosa
Central Retinal Vein Occlusion
Retinoblastoma
Eales Disease
Retinopathy of Prematurity
Leukemias
Retinopathy, Diabetic, Background
Macroaneurysm
Retinopathy, Diabetic, Proliferative
Melanoma, Choroidal
Retinopathy, Hemoglobinopathies
Melanoma, Ciliary Body
Sarcoidosis
Melanoma, Iris
Uveitis, Intermediate
Neovascular Membranes, Subretinal
Neovascularization, Choroidal
Ocular Ischemic Syndrome

Other Problems to Be Considered

Most commonly encountered differential diagnoses in decreasing order of frequency include the following:

Proliferative diabetic retinopathy
Posterior vitreous detachment
Trauma (blunt or penetrating, including shaken baby syndrome/child abuse)
Retinal tear
Retinal vein occlusion
Hypertensive retinopathy
Subarachnoid hemorrhage (Terson syndrome)
Avulsed retinal vessels
Age-related macular degeneration
Radiation retinopathy
Macroaneurysms

Others rare causes of vitreous hemorrhage include the following:

Complications of surgical procedures

Retinal laser photocoagulation
Intruding (scleral erosion) scleral buckle
Trabeculectomy
Globe perforation during retrobulbar or peribulbar surgery/anesthesia
Intraocular lens implantation or removal
Neovascularization from cataract wound

Tumors

Malignant choroidal melanoma
Melanocytoma of optic nerve disc
Astrocytic hamartoma of the retina
Retinoblastoma
Cavernous hemangioma of optic nerve disc

Vascular/neovascular

Coats disease/retinal telangiectasia
Retinopathy of prematurity (ROP)
Ocular ischemic syndrome
Branch retinal artery occlusion
Central retinal artery occlusion
Retinal angiomatosis
Retinal vasculitis
Hyperviscosity syndrome
Sarcoid posterior uveitis
Persistent hyaloid artery
Congenital prepapillary
Vascular loop venous stasis retinopathy
Dominant (familial) exudative vitreoretinopathy
Incontinentia pigmenti
Norrie disease

Inflammation

Behçet disease
Presumed ocular histoplasmosis syndrome
Eales disease
Uveitis (including pars planitis)
Syphilitic retinitis
Dermatomyositis
Systemic lupus erythematosus (SLE)
Toxocara

Hematologic disorders

Thrombocytopenia
Idiopathic thrombocytopenia purpura
Thrombotic thrombocytopenic purpura
Leukemia
Hemophilia
Disseminated intravascular coagulation
Protein C deficiency
Antiphospholipid antibodies
Von Willebrand syndrome

Miscellaneous causes

Talc retinopathy
Retinitis
Pigmentosa Valsalva retinopathy

Workup

Laboratory Studies

  • Consider ordering laboratory studies as per the suspected underlying etiology and its corresponding differential diagnosis. See Differentials.

Imaging Studies

  • Consider ordering imaging studies as per the suspected underlying etiology and its corresponding differential diagnosis.
    • With CT scan and/or MRI, exclude globe perforation, intraocular foreign body, avulsed optic nerve, intraocular tumor, displaced scleral buckle, and intraocular lens materials. See Differentials.
    • Ocular B-scan ultrasonography is used when the media is opacified enough to preclude a complete and clear (including view of the ora serrata) funduscopic examination.

More on Hemorrhage, Vitreous

Overview: Hemorrhage, Vitreous
Differential Diagnoses & Workup: Hemorrhage, Vitreous
Treatment & Medication: Hemorrhage, Vitreous
Follow-up: Hemorrhage, Vitreous
References

References

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Further Reading

Keywords

vitreous hemorrhage, retinal vascular tears, neovascularization of the retina, retinal neovascularization, retinal detachment, proliferative diabetic retinopathy, posterior vitreous detachment

Contributor Information and Disclosures

Author

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Norman P Blair, MD, Director, Vitreoretinal Division, Laboratory of Retinal Circulation and Metabolism, Illinois Eye and Ear Infirmary; Professor, Department of Ophthalmology, University of Illinois at Chicago
Norman P Blair, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Diabetes Association, American Ophthalmological Society, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

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.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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