This may occur spontaneously or after
trauma. The main causes of spontaneous vitreous
haemorrhage are: posterior vitreous
detachment with or without retinal breaks, proliferative
diabetic retinopathy, central retinal
vein occlusion and subretinal neovascular membrane in
age-related macular degeneration
with breakthrough bleeding.
Sudden onset of floaters causing impaired
Depending on the severity of the haemorrhage,
the view may be impossible with
a direct ophthalmoscope (it is then
important to examine the good eye which may
provide clues such as in diabetes
Refer within 24 hours
In the casualty, the ophthalmologists
will examine the eye for any posterior vitreous
detachment and diabetic changes.
An ultrasound is often performed if
the view is poor to exclude a retinal detachment
These patients require close observation
until the cause has been established or treated
This diabetic patient complains
of blurred right vision. Fundoscopy
reveals a subhyaloid haemorrhage
(haemorrhage between the retina
and the vitreous). Note the haemorrhage
has a fluid level (which is
typical of subhyaloid haemorrhage)
and the presence of previous laser
photocoagulation scars. This patient
certainly has new vessels and
requires further laser photocoagulation.
with severe diabetic retinopathy showing the presence of new vessels at
Without treatment in the form of photocoagulation, these vessels invariably
cause vitreous haemorrhage.
Another eye with diabetic retinopathy.
The new vessels are at the periphery of
the retina. Again without treatment,
it can cause visual loss through haemorrhages.
to sudden visual loss