Vitreous Hemorrhage Treatment & Management

  • Author: Brian A Phillpotts, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jun 8, 2011
 

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

  • Depends 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  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.

Specialty Editor Board

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, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor 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, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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 Other; Topcon Medical Lasers Consulting fee Consulting

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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