Abstract
Vitreous haemorrhage can be caused by a disruption of normal retinal vessels, bleeding from diseased retinal vessels, bleeding from abnormal new vessels or extension of haemorrhage through the retina from other sources. In the elderly, vitreous haemorrhage usually occurs spontaneously and only occurs occasionally as a result of trauma. Appropriate management of vitreous haemorrhage is dependent on the most likely cause in a particular patient. As always, an accurate medical history with a careful clinical examination, static and dynamic ultrasonography performed by an experienced examiner, results of other laboratory tests and an understanding of the common causes of vitreous haemorrhage in each age group is essential to come to a ‘best guess’ diagnosis as to the cause of the vitreous haemorrhage and thus guide the physician toward the appropriate management.
Immediate surgical removal of blood if indicated, as well as improving the vision gives the added benefit of allowing a full examination of the underlying retina. For those in whom surgical removal of blood is not recommended, a careful and frequent follow-up with serial B-scan ultrasound allows the ‘best guess’ diagnosis to be confirmed at each visit, until such time as the vitreous haemorrhage resolves sufficiently to allow a full and proper examination of the retina. Where there is a confirmed retinal tear, retinal detachment or other fundal pathology these are treated appropriately with laser or surgery (vitrectomy).
Preventative measures are dependent on the underlying cause of vitreous haemorrhage. Some of the underlying causes such as posterior vitreous detachment cannot be prevented. In others, such as retinal vein occlusion, measures may need to be taken so as to reduce the risk of a similar event in the same or fellow eye and to reduce the risk of potentially life-threatening associated systemic conditions such as a stroke or myocardial infarction.
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References
Spraul CW, Grossniklaus HE. Vitreous hemorrhage. Surv Ophthalmol 1997; 42(1): 3–39
Lindgren G, Lindblom B. Causes of vitreous hemorrhage [review]. Curr Opin Ophthalmol 1996; 7(3): 13–9
Lindgren G, Sjodell L, Lindblom B. A prospective study of dense spontaneous vitreous hemorrhage. Am J Ophthalmol 1995; 119(4): 458–65
Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology 1994; 101(9): 1503–13
Wilkinson CP, Rice TA. Michel’s retinal detachment. 2nd ed. St Louis: CV Mosby, 1997: 31
Sharma S, Walker R, Brown GC, et al. The importance of qualitative vitreous examination in patients with acute posterior vitreous detachment. Arch Ophthalmol 1999; 117(3): 343–6
Richardson PS, Benson MT, Kirkby GR. The posterior vitreous detachment clinic: do new retinal breaks develop in the six weeks following an isolated symptomatic posterior vitreous detachment? Eye 1999; 13 (Pt 2): 237–40
Sarrafizadeh R, Hassan TS, Ruby AJ, et al. Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. Ophthalmology 2001; 108(12): 2273–8
Tolentino FL, Lee P-F, Schepens CL. Biomicroscopic study of vitreous cavity in diabetic retinopathy. Arch Ophthalmol 1967; 75: 23–30
Dana MR, Werner MS, Viana MA, et al. Spontaneous and traumatic vitreous haemorrhage. Ophthalmology 1993; 100: 1377–83
Hayreh SS, Rojas P, Podhajsky P, et al. Ocular neovasularization with retinal vascular occlusion: III. incidence of ocular neovascuarization with retinal vein occlusion. Ophthalmology 1983; 90: 488–509
Dodson PM, Kritzinger EE, Clough CG. Diabetes mellitus and retinal vein occlusion in patients of Asian, West Indian and White European origin. Eye 1992; 6: 66–8
Rabb MF, Gagliano DA, Teske MP. Retinal arterial microaneurysms. Surv Ophthalmol 1988; 33: 73–96
Ohno-Matsui K, Hayano M, Futagami S, et al. Spontaneous involution of a large retinal arterial macroaneurysm. Acta Ophthalmol Scand 2000; 78(1): 114–7
Cunliffe IA, Rennie IG. Choroidal melanoma presenting as vitreous haemorrhage. Eye 1993; 7: 711–3
Gunduz K, Shields CL, Shields JA, et al. Presumed choroidal granuloma with vitreous hemorrhage resembling choroidal melanoma. Ophthalmic Surg Lasers 1998; 29(5): 422–5
Ogawa T, Kitaoka T, Dake Y, et al. Terson syndrome: a case report suggesting the mechanism of vitreous hemorrhage. Ophthalmology 2001; 108(9): 1654–6
McRae M, Teasell RW, Canny C. Bilateral retinal detachments associated with Tersons syndrome. Retina 1994; 14(5): 467–9
Naseri A, Blumenkranz MS, Horton JC. Terson’s syndrome following epidural saline injection [letter]. Neurology 2001; 57(2): 364
Gnanaraj L, Tyagi AK, Cottrell DG, et al. Referral delay and ocular surgical outcome in Terson syndrome. Retina 2000; 20(4): 374–7
Purdie AT, Olson JA. A case of pseudo-Terson’s syndrome. Eye 1999; 13: 690–1
Chen S, Cahill M, Barry P. Cluster of four cases of inadvertent injury to the globe secondary to peribulbar anaesthesia. Br J Ophthalmol 1998; 82(7): 850–1
Wearne MJ, Flaxel CJ, Gray P, et al. Vitreoretinal surgery after inadvertent globe penetration during local ocular anesthesia. Ophthalmology 1998; 105(2): 371–6
Labelle PF, Lapointe A, Boucher MC. Vitreous hemorrhage following retrobulbar anaesthesia. Can J Ophthalmol 1996; 31(1): 21–4
Gillow JT, Aggarwal RK, Kirkby GR. Ocular perforation during peribulbar anaesthesia. Eye 1996; 10 (Pt 5): 533–6
Kersey JP, Sleep T, Hodgkins PR. Ocular perforation associated with local anaesthetic for dacryocystorhinostomy. Eye 2001; 15 (Pt 5): 671–2
Dinakaran S, Kayarkar VV. Intraoperative ocular damage caused by a cannula. J Cataract Refract Surg 1999 May; 25(5): 720–1
Summanen P, Immonen I, Kivela T, et al. Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma. Br J Ophthalmol 1996; 80(8): 732–9
Krepier K, Wedrich A, Schranz R. Intraocular hemorrhage associated with dental implant surgery. Am J Ophthalmol 1996; 122(5): 745–6
Kokame GT. Vitreous hemorrhage after intravitreal tissue plasminogen activator (t-PA) and pneumatic displacement of submacular hemorrhage. Am J Ophthalmol 2000; 129(4): 546–7
Mootha VV, Schluter ML, Das A. Intraocular hemorrhages due to warfarin fluconazole drug interaction in a patient with presumed Candida endophthalmitis. Arch Ophthalmol 2002; 120(1): 94–5
Tilanus MA, Vaandrager W, Cuypers MH, et al. Relationship between anticoagulant medication and massive intraocular hemorrhage in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2000; 238(6): 482–5
Manuchehri K, Loo A, Ramchandani M, et al. Acute suprachoroidal haemorrhage in a patient treated with streptokinase for myocardial infarction. Eye 1999; 13(5): 685–6
Chorich LJ, Derick RJ, Chambers RB, et al. Haemorrhagic ocular complications associated with the use of systemic thromolytic agents. Ophthalmology 1988; 105: 482–31
West JF, Gregor ZJ. Fibrovascular ingrowth and recurrent haemorrhage following diabetic vitrectomy. Br J Ophthalmol 2000; 84(8): 822–5
Wu WC, Chang SM, Chen JY, et al. Management of postvitrectomy diabetic vitreous hemorrhage with tissue plasminogen activator (t-PA) and volume homeostatic fluid-fluid exchanger. J Ocul Pharmacol Ther 2001; 17(4): 363–71
Koutsandrea C, Apostolopoulos M, Theodossiadis P. The use of tissue plasminogen activator in postvitrectomy cases. Int Ophthalmol 1993; 17(2): 95–100
Zhao P, Wang W, Song H, et al. Repetitive, low-dose tissue plasminogen activator for clearance of experimental vitreous hemorrhage. Yan Ke Xue Bao 1995; 11(1): 29–31, 40
Min WK, Kim YB, Ahn BH, et al. Repetitive, low-dose tissue plasminogen activator for clearance of experimental vitreous hemorrhage. Korean J Ophthalmol 1994; 8(2): 45–8
Johnson RN, Olsen KR, Hernandez E. Intrevitreal tissue plasminogen activator treatment of experimental vitreous haemorrhage. Arch Ophthalmol 1989; 107(6): 891–4
The Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology 1995; 102: 647–61
Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS Report Number 9. Ophthalmology 1991; 98: 766–85
The Diabetic Retinopathy Vitrectomy Study Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision: clinical application of results of a randomized trial. Diabetic Retinopathy Vitrectomy Study Report 4. Ophthalmology 1998; 95(10): 1321–34
Boehm BO, Lang GK, Jehle PM, et al. Ocreotide reduces vitreous haemorrhage and loss of visual acuity risk in patients with high-risk proliferative diabetic retinopathy. Horm Metab Res 2001; 33(5): 300–6
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Manuchehri, K., Kirkby, G.R. Vitreous Haemorrhage in Elderly Patients. Drugs Aging 20, 655–661 (2003). https://doi.org/10.2165/00002512-200320090-00003
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DOI: https://doi.org/10.2165/00002512-200320090-00003