Vitreous Hemorrhage in Emergency Medicine Workup

Updated: Aug 04, 2017
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Robert E O'Connor, MD, MPH  more...
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Workup

Laboratory Studies

No specific laboratory test is used in diagnosing vitreous hemorrhage. Testing to determine underlying medical conditions may be necessary once the 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 able to reliably evaluate for retinal detachments using bedside ultrasonography. [3] However, in this study, vitreous hemorrhages were sometimes 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 with ophthalmic ultrasonography is based on 3 distinct findings, as follows:

  • Retinal detachments can be followed posteriorly 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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