eMedicine Specialties > Ophthalmology > Vitreous

Hemorrhage, Vitreous: Treatment & Medication

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

Treatment

Medical Care

  • Treatment 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 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.)
    • Vitreous hemorrhage associated with rubeosis
    • Vitreous hemorrhage associated with hemolytic or ghost-cell glaucoma

Consultations

  • Depends on the suspected underlying etiology and most likely differential diagnoses. See Differentials.
  • Retinal specialist

Medication

Medical therapy depends on the suspected underlying etiology and the most likely differential diagnosis. See Differentials. Avoid drugs such as aspirin and other anticlotting agents when necessary.

More on Hemorrhage, Vitreous

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

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Further Reading

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Keywords

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

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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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