What is vitreous haemorrhage?

A vitreous haemorrhage is a bleed inside the cavity of the eye.

If you develop a vitreous haemorrhage, you may experience a shower of floaters, commonly described like a veil or swelling smoke.  The vision may become very blurred.  It is important to have an eye examination as soon as possible, because some of the causes of bleeding may require immediate treatment.  Although most bleeds can and do clear by themselves given time, occasionally there are underlying retinal problems which require urgent surgery.  It is best to have a prompt assessment by an ophthalmologist to decide on the best course of action in your case.  An ultrasound scan is sometimes required if the blood obscures the view and we cannot see your retina adequately on the microscope. 

Why does vitreous haemorrhage occur?

There are many possible causes for this, including:

Posterior vitreous detachment.  This is where the natural age related separation of the vitreous jelly from the retina can pull on a blood vessel overlying the retina, causing bleeding.

Diabetic retinopathy.  Retinal problems associated with diabetes include the formation of abnormal blood vessels, which can bleed.

High blood pressure.  High blood pressure increases the chances of bleeding from other causes.  It also contributes to the development of aneurysms, which are areas of dilated blood vessels.  These have thin walls and can sometimes bleed spontaneously.

Retinal vascular occlusions.  Blockages of blood vessels can occur in the retina the same as elsewhere in the body.  If a blood vessel becomes blocked, this can change the pressure inside the retinal circulation and also sometimes leads to the formation of new abnormal blood vessels.  This can lead to bleeding inside the eye.

How is vitreous haemorrhage treated?

It is important to establish the most likely reason for developing a vitreous haemorrhage. If there is significant diabetic retinopathy or a vascular occlusion present, a bleed like this is most likely to be a consequence of these conditions. We will usually offer a period of observation, typically a few weeks, to give the bleed a chance to disperse by itself. Surgery may be offered if the blood is not clearing quickly.

Patients developing a haemorrhage for unknown reasons will usually have a PVD as the cause. If the bleeding is mild and a thorough examination of the retina is possible, observation may also be offered in the first instance, as vitreous haemorrhage does clear spontaneously given time. If a good view of the retina is not achieved, we will usually recommend a vitrectomy operation. This allows us to clear the blood and examine the retina, which facilitates the treatment of any retinal problems which may have caused the bleeding.

What happens during a vitrectomy?

A vitrectomy procedure takes around from 30 minutes – 1 hour and is done as a day case procedure.  You will have some eye drops put in before surgery in order to dilate the pupils.  A local anaesthetic will be administered, usually in the form of an injection of anaesthetic next to the eye. A mild sedative may be administered to allow you to feel more relaxed.  We ask you to lie down on a bed and ensure that you are comfortable for the procedure.  The area around the eye will be cleaned with an antiseptic solution and a tented cover placed over half of the face to ensure cleanliness and comfort.  

A keyhole approach is used to remove the vitreous jelly inside the eye, together with the blood contained within it and a full retinal examination is performed.  Any retinal problems can be identified and treated. After surgery, it is common to leave a bubble of air inside the eye.  This will impair your vision for several days while the air bubble is slowly dispersing.  

After surgery, it is necessary to use regular eye drops for several weeks to control inflammation and help prevent infection.  We ask you to use a plastic protective shield around the eye at night time for a couple of weeks to prevent accidental injury.

Most operations proceed very smoothly, however sometimes if some other eye conditions or complicating features are present, the operation time and/or the recovery can be prolonged.  If this applies to you, the surgeon will discuss it with you before and after your operation and answer any questions you may have