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Vitreous Hemorrhage: Treatment & Medication

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

Treatment

Emergency Department Care

  • ED treatment of vitreous hemorrhage involves documentation with history and physical examination. Ophthalmologic consultation then is required.
  • Emergent consultation is required if hemorrhage has resulted from trauma or abuse or if retinal tear or detachment is suspected.
  • In medical conditions such as diabetes, peripheral neovascularization, or sickle cell disease, obtain a consultation within 48 hours and treat the patient as an outpatient.
  • Discharge instructions must include limiting physical activity and sleeping in an upright position.
  • Anticoagulants and other antiplatelet agents may need to be stopped immediately, but this must be considered on an individual patient basis weighing the risks and benefits of such cessation carefully with patients and their physicians. Studies in diabetic retinopathy, such as the Early Treatment Diabetic Retinopathy Study, with vitreous hemorrhage found no benefit from discontinuing aspirin therapy as far as preventing further or recurrent hemorrhage.4,5
  • Do not discharge patients from the ED until a time and date for the consultation is available.
  • Follow-up care should confirm that the patient saw a consultant.

Consultations

  • Ophthalmologic consultation is mandatory in vitreous hemorrhage.
  • A retinal specialist usually is necessary for medical and surgical intervention.
  • Treatment of vitreous hemorrhage depends upon the underlying cause. In retinal tears or detachment, laser cryotherapy or scleral buckle surgery is indicated. With underlying medical diseases, treat the patient conservatively with upright positioning for sleep to enhance settling of the hemorrhage.
  • With the exception of trauma and retinal detachment, close observation for 1-2 weeks allows time for spontaneous clearing of some hemorrhage, but it may take several months for vision to return, depending on the specific case and the underlying disease process. Surgical intervention with pars plana vitrectomy can restore vision (if the macular is healthy) when spontaneous clearing does not occur over a period of months.
  • Bilateral patching to limit eye movements and placing the patient in an upright position may accelerate the layering out of the blood and speed resolution.
  • New possibilities may be on the horizon that accelerate clot liquefaction (acetic acid), hemolysis (ultrasonography or anti–Rh-immunoglobulin), and phagocytosis (intravitreal interleukin 1).

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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