Vitreous Hemorrhage in Emergency Medicine Workup

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

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.
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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.

In an observational study, ED physicians have been shown to be reliably evaluate for retinal detachments using bedside ultrasonography.[4] However, in this study, vitreous hemorrhages were misidentified as retinal detachments. Although acute vitreous hemorrhages appear as minimal echogenic structures, over time they can become more organized and appear as a linear structure.

Distinguishing between retinal detachments and vitreous hemorrhages is based on 3 distinct findings, as follows:

  • Retinal detachments localize to the optic disc.
  • Unlike retinal detachments, vitreous hemorrhages remain horizontal when the patient moves their eye side to side.
  • Vitreous hemorrhages are often seen in the middle section of the posterior eye.
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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.

 
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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.
 
 
 
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