Vitreous Hemorrhage in Emergency Medicine Treatment & Management

  • Author: Gregory L Larkin MD, MD, MS, MSPH, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 20, 2011
 

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.[5, 6]
  • 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.
Next

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).
Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Gregory L Larkin MD, MD, MS, MSPH, FACEP  Professor, Department of Emergency Medicine, Yale University School of Medicine

Gregory L Larkin MD, 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.

Specialty Editor Board

Richard S Krause, MD  Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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 

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

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. Yoonessi R, Hussain A, Jang TB. Bedside ocular ultrasound for the detection of retinal detachment in the emergency department. Acad Emerg Med. Sep 2010;17(9):913-7. [Medline].

  5. 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].

  6. 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].

  7. 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].

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

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

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

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

 
Previous
Next
 
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.