ConditionEyes & vision
Vitreous Hemorrhage
A vitreous hemorrhage is bleeding into the vitreous, the clear gel that fills the back of the eye. Light can no longer pass clearly to the retina, causing sudden floaters, cobwebs, a red or dark haze, or severe loss of vision in one eye, usually without pain. The most common causes are diabetic retinopathy, a retinal tear from posterior vitreous detachment, retinal vein occlusion and eye injury. It needs prompt examination by an eye doctor, because the cause, such as a retinal tear, may need urgent treatment.
Also called: Vitreous bleed, bleeding in the eye (vitreous), intraocular hemorrhage
At a glance
- What it is
- Blood in the vitreous gel at the back of the eye.
- Symptoms
- Sudden floaters, cobwebs, red or dark haze, or vision loss in one eye, usually painless.
- Main causes
- Proliferative diabetic retinopathy, retinal tears, retinal vein occlusion, trauma.
- Urgency
- Same-day eye exam to look for a retinal tear or detachment.
- Diagnosis
- Dilated eye exam and ultrasound if the retina cannot be seen.
- Treatment
- Treat the cause (laser, injections), allow blood to clear, or vitrectomy surgery.
When to get help
Call 911 or go to the ER
- Sudden loss of vision, a shower of new floaters, flashing lights, or a curtain or shadow across vision (possible retinal tear or detachment). Get same-day emergency eye care
- Vision loss after an eye injury, or a penetrating injury
- Sudden painful vision loss with a red eye, headache and nausea
See a doctor within a day or two
- New floaters or a haze in vision in someone with diabetes
- Vision that is getting worse days after a known vitreous hemorrhage
Book a routine appointment
- Regular eye exams if you have diabetes, sickle cell disease or high blood pressure
- Follow-up of a vitreous hemorrhage that is clearing
What happens in a vitreous hemorrhage
The vitreous is normally clear and has no blood vessels. Bleeding into it usually comes from:
- abnormal new blood vessels on the retina that are fragile and bleed easily, as in diabetic retinopathy or after retinal vein occlusion
- tearing of a normal retinal blood vessel when the vitreous pulls away from the retina
- injury to the eye
Blood scattered through the gel blocks light, causing floaters or, if dense, profound vision loss. The body gradually clears the blood, often over weeks to months.
Causes
| Cause | Approximate share | Notes |
|---|---|---|
| Proliferative diabetic retinopathy | Most common in adults | Fragile new vessels on the retina bleed |
| Posterior vitreous detachment with or without retinal tear | Common | Age-related separation of the gel; a tear can lead to detachment |
| Retinal vein occlusion | Common | New vessels after a blocked vein |
| Eye trauma | Most common in young people | Blunt or penetrating injury |
| Sickle cell disease retinopathy | Less common | Especially hemoglobin SC disease |
| Wet macular degeneration | Less common | Bleeding breaks into the vitreous |
| Other | Rare | Retinal artery aneurysm, Terson syndrome (bleeding in the eye with brain hemorrhage), retinopathy of prematurity, tumors, blood disorders |
Blood thinners do not usually cause a vitreous hemorrhage on their own but can make bleeding from another cause worse.
Symptoms
- Sudden floaters: dark spots, specks, cobwebs or strands
- A red tint or haze
- Shadows or blurred vision
- In severe cases, vision reduced to light perception
- Symptoms may be worse in the morning, as blood settles overnight
- Usually painless
- Flashes of light suggest the vitreous is pulling on the retina
Diagnosis
- Visual acuity and eye pressure check.
- Dilated eye examination with a slit lamp and ophthalmoscope to see the retina and identify the cause.
- B-scan ultrasound when blood blocks the view, to check whether the retina is detached or torn.
- Examination of the other eye for clues, such as diabetic retinopathy.
- Imaging: fluorescein angiography or optical coherence tomography once the blood clears.
- Blood tests for diabetes, blood pressure and sometimes sickle cell or clotting disorders if the cause is unclear.
Treatment
Immediate measures
- Rest with the head of the bed raised, so blood settles and vision can improve
- Avoid heavy lifting and strenuous activity at first
- Do not stop prescribed blood thinners without talking to your doctor
- Follow-up exams, often within days to weeks, with ultrasound if the retina is not visible
Treating the cause
- Retinal tear: laser or freezing treatment (cryotherapy) to seal the tear and prevent detachment
- Retinal detachment: urgent surgery
- Diabetic retinopathy and vein occlusion: anti-VEGF injections into the eye and laser photocoagulation to shrink abnormal vessels
- Control of blood sugar and blood pressure
Vitrectomy
Surgery to remove the blood-filled vitreous and replace it with a clear solution is recommended when:
- a retinal detachment is present or suspected
- the blood does not clear after weeks to a few months
- both eyes are affected or vision is needed urgently
- treatment of the underlying cause requires a clear view
During vitrectomy, the surgeon can also apply laser to the retina.
Outlook
The outlook depends on the cause. Hemorrhages from posterior vitreous detachment without a tear often clear in weeks with good vision. Diabetic hemorrhages may recur unless the retinopathy is treated. Prompt diagnosis of retinal tears and detachment prevents permanent vision loss.
Prevention
- Keep blood sugar, blood pressure and cholesterol under control
- Have a dilated diabetic eye exam at least yearly
- Wear protective eyewear for sports and risky activities
- Know the warning signs of retinal detachment and act quickly
Frequently asked questions
What is a vitreous hemorrhage?
A vitreous hemorrhage is bleeding into the clear gel that fills the back of the eye. The blood blocks light reaching the retina, causing floaters, haze or sudden vision loss in one eye, usually without pain.
What causes vitreous hemorrhage?
The most common causes are diabetic retinopathy, retinal tears during posterior vitreous detachment, retinal vein occlusion and eye injuries. Less common causes include sickle cell disease, macular degeneration and bleeding in the brain.
How long does a vitreous hemorrhage take to clear?
Small hemorrhages may clear in a few weeks. Larger ones can take several months. If the blood does not clear, or the retina is torn or detached, vitrectomy surgery may be needed.
Is vitreous hemorrhage an emergency?
It needs urgent same-day eye examination, because it may be caused by a retinal tear or detachment that needs prompt treatment to save vision. Sudden floaters with flashes or a curtain over vision are especially urgent.
Can vitreous hemorrhage cause blindness?
The bleeding itself usually clears, but the underlying cause, such as retinal detachment or advanced diabetic retinopathy, can lead to permanent vision loss if not treated. Early diagnosis and treatment protect vision.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Vitreous hemorrhage
- American Academy of Ophthalmology Preferred Practice Pattern: Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration
- American Academy of Ophthalmology Preferred Practice Pattern: Diabetic Retinopathy
- National Eye Institute: Diabetic Retinopathy; Retinal Detachment
- American Society of Retina Specialists: Vitreous hemorrhage