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Vitreous Hemorrhage: Differential Diagnoses & Workup

Author: Gregory Luke Larkin, MD, MS, MSPH, FACEP, Professor of Surgery, Associate Director of Emergency Medicine, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Apr 7, 2008

Differential Diagnoses

Anemia, Sickle Cell
Retinal Detachment
Retinal Vein Occlusion
Subarachnoid Hemorrhage
Systemic Lupus Erythematosus

Other Problems to Be Considered

Aneurysms (choroidal, cerebral)
Aortic arch syndromes
Arteriovenous malformations
Blood disorders (anticoagulants, thrombocytopenia, ITP)
Blunt and penetrating trauma (including shaken baby syndrome, child abuse)
Carotid-cavernous fistula
Diabetic retinopathy
Dominant (familial) exudative vitreoretinopathy
Eales disease
Hypertensive retinopathy
Hyperviscosity syndromes; chronic leukemia
Incontinentia pigment
Beh ç et disease
Toxocara
Norrie disease
Ocular surgery complications
Malignant choroidal melanoma
Retinoblastoma
Cavernous hemangioma of the optic nerve disc
Retinal angiomatosis
Retinal emboli (eg, talc)
Retinal telangiectasia
Retinal vasculitis, including arteriolitis
Retinal vein rupture
Retinopathy of prematurity
Retinoschisis
Sarcoidosis
Terson syndrome (SAH)
Ulcerative colitis, Crohn disease
Uveitis including pars planitis

Workup

Laboratory Studies

  • No specific laboratory test exists to use in diagnosing vitreous hemorrhage. Testing to determine underlying medical conditions may be necessary once etiology of the hemorrhage is determined.
  • Coagulation studies may be helpful in selected patients.

Imaging Studies

  • Ultrasonography is the mandatory imaging technique when the view of the fundus is obstructed by hemorrhage, corneal opacification, or cataract.
  • Experienced ultrasonographers can confirm if the retina is attached, if an intraocular foreign body is present, and if a PVD exists.

More on Vitreous Hemorrhage

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

  1. Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. Jul-Aug 1997;42(1):3-39. [Medline].

  2. Litten M. Uber cinige vom allgemein-klinischen Standpunkt aus interessante Augenveranderungen. Berl Kline Wochenscher. 1881;18:23-27.

  3. McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. Mar 2004;75(3):491-3. [Medline].

  4. Chew EY, Klein ML, Murphy RP, et al. Effects of aspirin on vitreous/preretinal hemorrhage in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report no. 20. Arch Ophthalmol. Jan 1995;113(1):52-5. [Medline].

  5. Effects of aspirin treatment on diabetic retinopathy. ETDRS report number 8. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. May 1991;98(5 Suppl):757-65. [Medline].

  6. Flynn HW, Chew EY, Simons BD, et al. Pars plana vitrectomy in the Early Treatment Diabetic Retinopathy Study. ETDRS report number 17. The Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. Sep 1992;99(9):1351-7. [Medline].

  7. Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 1998:1089-119.

  8. Rosen P, Baker FJ, Barkin RM. Emergency Medicine: Concepts and Clinical Practice. 1988:1033-49.

  9. Rosen P, Barkin RM, Sternbach GL. Essentials of Emergency Medicine. 1991:553-66.

  10. Tintinalli JE, Krome RL, Ruiz E. Emergency Medicine: A Comprehensive Study Guide. 1992:833-40.

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Further Reading

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Keywords

vitreous hemorrhage, vitreoretinal disease, posterior pole, gelatinous substance, subinternal limiting membrane hemorrhage, retrohyaloid hemorrhage, subhyaloid hemorrhage, blood in vitreous, subarachnoid hemorrhage, SAH  

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Contributor Information and Disclosures

Author

Gregory Luke Larkin, MD, MS, MSPH, FACEP, Professor of Surgery, Associate Director of Emergency Medicine, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine
Gregory Luke Larkin, MD, MS, MSPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Society for Bioethics and Humanities, Association for the Advancement of Automotive Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Clinical Assistant Professor, Residency Program Director, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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