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Vitreous Hemorrhage Treatment & Management

  • Author: Brian A Phillpotts, MD, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: May 04, 2015
 

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.

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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.)[4]
  • Vitreous hemorrhage associated with rubeosis
  • Vitreous hemorrhage associated with hemolytic or ghost-cell glaucoma
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Consultations

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

Retinal specialist

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Contributor Information and Disclosures
Author

Brian A Phillpotts, MD, MD 

Brian A Phillpotts, MD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, National Medical Association

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 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, Macula Society, Retina Society, Club Jules Gonin

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

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, Pan-American Association of Ophthalmology

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.

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