Vitreous Hemorrhage Treatment & Management

Updated: Sep 07, 2018
  • Author: Brian A Phillpotts, MD, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Treatment

Medical Care

Treatment of vitreous hemorrhage 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 of vitreous hemorrhage management 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.) [3]

  • Vitreous hemorrhage associated with rubeosis

  • Vitreous hemorrhage associated with hemolytic or ghost-cell glaucoma

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Consultations

Consultations depend on the suspected underlying etiology and most likely differential diagnoses. See Differentials.

Retinal specialist

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Prevention

A study by Smith and Steel has shown a certain amount of evidence to support that using antivascular endothelial growth factor preoperatively in diabetic vitrectomy can lower the occurrence of early postoperative vitreous cavity hemorrhage. [4]

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Further Outpatient Care

Initially, patients with vitreous hemorrhage are monitored daily for 2-5 days to rule out retinal tear or detachment, then every 1-2 weeks for spontaneous clearing. However, in the event that the dense vitreous hemorrhage persists without known underlying cause, a B-scan ultrasonography should be serially performed.

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