Ophthalmology

Vitreous hemorrhage

English: vitreous body hemorrhage

Synonyms

Medical: Intravitreal bleeding

Definition of vitreous hemorrhage

Vitreous hemorrhage is the penetration of blood into the vitreous space of the eye. This is located behind the eye lens.

Detecting vitreous hemorrhage

What are the symptoms of vitreous hemorrhage?

The blood that penetrates in a vitreous hemorrhage can cause symptoms of varying severity, depending on the amount. At the beginning, the patient perceives short-term changes in the image perception: dark appearing opacities that are described as black flakes or soot flakes. Other descriptions speak of "cobwebs" or floating particles.
Many patients describe moving shadows and seeing points. Another symptom can be (light) flashes that the patient perceives, which could also indicate a vitreous detachment.
These suddenly appearing swarms of mosquitos or soot rain-like spots in the field of vision come from the blood, which is located in the vitreous space and moves back and forth following gravity. Therefore, those affected usually complain about these complaints in the morning after getting up. The field of view describes the points that the human eye can perceive if no object or head movement is carried out.

Read more on the topic: Eye pain

How is vitreous hemorrhage treated?

The diagnosis of vitreous hemorrhage is made by the ophthalmologist by asking the patient to describe the symptoms and then using the slit lamp to look into the eye. The bleeding is usually easy to see. The ophthalmologist (specialist in ophthalmology) examines the eye thoroughly for the retinal hole. If the assessment is difficult, an ultrasound of the eye may be necessary.

Treating vitreous hemorrhage

How is vitreous hemorrhage treated?

The type of treatment for vitreous hemorrhage depends on a number of factors. On the one hand, the severity of the bleeding and, on the other hand, whether it is a first-time event. Before therapeutic measures are taken, there are suggestions for how patients should behave in the event of a vitreous hemorrhage.
The patient should be in a resting position. That means that he positions himself upright (Upper body elevation) and so remains. By not moving the head and body, a worsening of the symptoms should be counteracted.
The blood which is in the vitreous humor and which causes the problems should, if possible, not spread further; however, when the head is moved there is a risk that the blood will spread to parts of the vitreous humor that are not yet affected. This would further worsen the symptoms.
Another advantage of keeping calm is that blood that has already been swirled up settles faster and fewer parts of the vitreous are affected by the blood streaks.
In addition, as a first therapeutic measure, a bandage on both eyes (Binoculus) can be created. This is a roll bandage that pulls around the eyes and head. This should support the immobilization of the eyes in addition to the behavior mentioned above.

Other behavioral suggestions describe that the patient continues to move normally without taking a rest position. It is assumed here that the distribution of the blood can result in faster spontaneous absorption. The main opinion, however, lies in the above-mentioned mechanisms for immobilizing the head and eyes.

If the vitreous hemorrhage regresses naturally and the symptoms subside, then one speaks of spontaneous resorption. This should occur within the next few days after a bleeding event.
If it is a minor and first-time vitreous hemorrhage, you can wait a few days to see whether spontaneous resorption occurs. Should this occur, the origin of the bleeding must be clarified in the next step, e.g. a vessel of the retina (retina).
In such a case, laser coagulation can be used. This is based on the fact that the affected vessels are obliterated. The laser destroys the cells in this area of the retina - they become necrotic (die off). However, these are very small areas of the retina so that the patient usually cannot perceive them.

However, if the bleeding is profuse, persistent or recurring, surgical removal of the vitreous (Vitrectomy) be considered. In these cases there is usually too much blood in the vitreous humor for it to be completely absorbed (reduced) could be. Another indication for a vitrectomy is when a detachment of the mesh or tears in the retina are diagnosed.

In a vitrectomy, the vitreous is removed or suctioned. The vitreous body, which is part of the middle segment of the eye, maintains the shape of the eye - it ensures that the eye does not collapse. This is why the space created in a vitrectomy is filled with infusion solution so that the intraocular pressure can be maintained. In this operation, several smaller, millimeter-sized incisions are made, which are made on the edge of the cornea. The surgical equipment is introduced through these incisions: a lighting device, the infusion and other tools such as scissors and hooks. This work is carried out with the aid of a microscope.

What homeopathic remedies can help with vitreous hemorrhage?

There are isolated reports of successful treatments with homeopathic remedies in specialist literature, for example of a very overweight patient with long-term diabetes who has severe visual loss due to vitreous hemorrhage (Loss of vision) had suffered. He took Phosphorus D 30 for three days and almost regained his original vision.
Here, however, it is impossible to say whether the body would not have cleared the bleeding all by itself after three days, even without assistance. Further positive results were achieved with the treatment with potassium chloratum and witch hazel, with a similarly difficult to detect mode of action.

Preventing vitreous hemorrhage

What are the causes of vitreous hemorrhage?

Bleeding from retinal vessels, for example, is a possible cause. This happens when the retina becomes detached from its support. Vessels can tear off and cause this bleeding. Other possible causes are:

Increased vascularization in diabetics or occlusion of the central vein of the retina
Small widening of retinal vessels or calcifications of the like
Bleeding from a vascular tumor in the retina

How can vitreous hemorrhage be prevented?

Vitreous hemorrhage is difficult to prevent because it usually results from retinal detachment. Retinal detachment is a very serious condition that can lead to blindness.

How is vitreous hemorrhage triggered?

With vitreous hemorrhage, blood penetrates into what is known as the vitreous space of the human eye. The vitreous space makes up about 80% of the total eye and is usually filled with a see-through clear liquid.
The blood that has penetrated the vitreous humor can cloud the fluid inside, which then leads to impaired vision, generally blurred vision and, due to the red hemoglobin in the blood, a generally reddish coloration of the environment leads. How severe this impairment is perceived depends on the severity and extent of the bleeding. In mild cases, patients notice a few dark spots in their field of vision. These are not problematic, but are described as extremely annoying. However, if the bleeding is more severe, the patient's eyesight may be directly affected and may be so severely restricted that only light-dark can be perceived or the vision is almost completely lost.

However, this only happens very rarely and would be the "worst case"Scenario. The causes of a vitreous hemorrhage can be very diverse. The most common is diabetic retinopathy, where long-standing diabetes slowly and gradually leads to clouding of the retina.

Another large patient collective can be found among extreme athletes and young people with physically demanding, dangerous jobs. Here, external injuries can lead to bleeding into the vitreous humor. Another risk factor for triggering a vitreous hemorrhage is psychological stress, as it can cause latent high blood pressure, making bleeding more likely.

Since the causes are so diverse, so are the therapeutic approaches. In general, one tries first and foremost to identify and treat the underlying disease that may be present.
However, relatively little can be done about the blood in the vitreous itself. As long as the retina itself is not damaged, it is common to simply let the body's self-healing processes work, which through natural processes ensure that the blood is gradually broken down and thus also the vision improves.
Because you want to protect the eye, which is a very small but all the more sensitive organ, as much as possible from surgical interventions, as these always involve the risk of rebleeding or other complications.

If an operation is unavoidable, however, one is able to suck off the liquid and blood in the vitreous and replace it with an artificially produced substitute solution, usually based on salt or the like.

Course of a vitreous hemorrhage

What is the prognosis for vitreous hemorrhage?

Vitreous hemorrhage can recede entirely as the blood is reabsorbed. Usually, however, the operation follows. Statistically speaking, there are more retinal detachments after this operation than in the eyes that were not operated on. Opacities of the lens, which result in cataract surgery, are also the result.
You can find more about this under our cataract topic.

How long does a vitreous hemorrhage last?

The duration of a vitreous hemorrhage, like the causes, is very variable and depends primarily on the severity of the severity of the bleeding.

Is it only a moderate form of bleeding and is the person affected by the symptoms occurring in their everyday life (like the dark spots in the field of vision, the slightly reddish-orange clouding and possibly small defects in the field of vision) are not restricted further, doctors advise against any further treatment but, as unusual as it may sound, simply wait and let the body's own self-healing processes work.
The body is able to get rid of bleeding without any help, as everyone has been able to observe from and with a bruise. Depending on the extent of the bleeding and how fit and healthy the body is, this process can take several months, which is completely normal.

If you decide to have an operation because the bleeding is so massive or there is a threat of other complications, the bleeding itself is quickly repaired, but, as already mentioned above, you have to physically back off for some time after the operation and protect.

Further questions about vitreous hemorrhage

Can you do sports with a vitreous hemorrhage?

Exercise is important in two ways when it comes to vitreous hemorrhage.

On the one hand, there is an increased risk of vitreous hemorrhage through exercise, especially through physically dangerous sports or extreme sports in general. This is because such vitreous hemorrhage can also be triggered by external injuries in the head area or the eye itself. And the more hard physical contact, for example in rugby or the like, the higher the likelihood of getting injured in the eye.
And in a number of extreme sports, blood pressure can rise very sharply in the meantime, and high blood pressure in turn increases the risk of bleeding. In the case of bleeding caused by high blood pressure, the first thing to do is to tear the small and smallest vessels, such as the blood vessels in the eye, and so it can bleed in preferentially there.

Another important aspect of exercise in connection with vitreous hemorrhage is avoiding it, should one opt for surgical removal of the bleeding and thus for surgical removal of the vitreous body (Vitrectomy) have decided. During this procedure, needles are introduced into the eye by means of three very small punctures, through which the gel-like liquid with which the vitreous humor is filled, together with the interfering blood contained therein, is sucked off. The resulting empty space is usually filled with air, gas or a silicone oil, which, due to the laws of physics, behave in such a way that they cannot easily emerge from the eye by themselves, and the needles are removed again.
The procedure takes about 30-60 minutes and is carried out as an inpatient; the patients remain in the hospital for three to six days, depending on the course of the operation. It is important to position the patient, especially the head, in a certain position after the operation.

The pain is very limited due to the minimally invasive technique. Sometimes there is a certain foreign body sensation in the eye for a few days after the operation. In the period after the operation, it is forbidden for the patient to exert themselves physically, which of course includes exercise in terms of sport. Here, too, the focus is on the risk of injury and the risk of a rise in blood pressure.

Furthermore, there is talk of possible visual field defects, which means that certain parts of the maximally perceptible space appear blind. This can have different causes; as well as a vitreous hemorrhage.

Further symptoms are a discoloration of the visual field in a cloudy reddish color. The red color is also due to the vitreous hemorrhage.

If you have slight vitreous hemorrhage, it may be that, in addition to the perceived changes in the visual field, there is no reduction in visionReduced visual acuity) occurs. However, the heavier the vitreous hemorrhage, the higher the likelihood of decreased visual acuity.
Basically, a blood volume of 10 µl can cause a reduction in vision at which the patient can just barely perceive hand movements.
Vitreous hemorrhage can also be so pronounced that the attending physician has difficulty seeing into the eye and the patient suffers reversible blindness (this is reversible, i.e. it is not a question of permanent blindness).

The bleeding typically does not cause pain; there is talk of a painless loss of vision

The symptoms of vitreous hemorrhage may depend on the severity of the bleeding, as described. With regard to the persistence of the symptoms, it can be assumed that they are reduced by the breakdown of the penetrated blood.

You may also be interested in this topic: Vitreous detachment