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.
All patients with symptoms and/or signs of posterior vitreous detachment (pvd), even in the absence of vitreous hemorrhage, should be referred to an ophthalmologist for a retinal examination following pupillary dilation.
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 with vitreous hemorrhage, such as the Early Treatment Diabetic Retinopathy Study, found no benefit from discontinuing aspirin therapy as far as preventing further or recurrent hemorrhage. [4, 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.
Consultations
Ophthalmologic consultation is mandatory in vitreous hemorrhage.
A retinal specialist usually is necessary for surgical intervention.
Treatment of vitreous hemorrhage depends on the underlying cause. In symptomatic retinal tears with vitreous hemorrhage, laser or cryotherapy is generally indicated. In retinal detachment, pars plana vitrectomy or scleral buckling 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 hemorrhage removal by pars plana vitrectomy can restore vision (if the macula 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 of the hemorrhage.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
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Vitreous hemorrhage. Courtesy of UT Southwestern Medical School, Department of Ophthalmology.
