Bleeding in the vitreous cavity

Aetiology

• Rupture of normal vessels from mechanical force e.g. trauma, retinal tear/PVD
• Haemorrhage from pathological structures e.g. rupture of retinal neovascularization from diabetic retinopathy or retinal vein occlusion

Clinical features

Symptoms

• Sudden, painless visual loss or haze
• Red hue in vision - worst when lying flat as this causes the blood to pool on the macula
• May describe new onset floaters

Signs

• Loss of red reflex - vitreous hemorrhage can obstruct light from focusing on the retina

Investigations

• Dilated fundoscopy: may show haemorrhage in the vitreous cavity

• Slit-lamp examination: red blood cells in the anterior vitreous
• Ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
• Fluorescein angiography: to identify neovascularization
• Orbital CT: used if open globe injury

Management

• Treat underlying aetiology