From the Guidelines
Posterior vitreous hemorrhage in the eye is primarily caused by bleeding into the vitreous cavity, often resulting from conditions such as diabetic retinopathy, retinal tears or detachments, trauma, posterior vitreous detachment, age-related macular degeneration, and retinal vein occlusions, as supported by recent studies 1. The most common causes of posterior vitreous hemorrhage include:
- Diabetic retinopathy, where abnormal blood vessels grow and rupture
- Retinal tears or detachments that damage blood vessels
- Trauma to the eye
- Posterior vitreous detachment, where the vitreous gel separates from the retina and can tear blood vessels
- Age-related macular degeneration with bleeding
- Retinal vein occlusions that increase pressure in retinal vessels Less common causes include blood disorders, certain medications like anticoagulants, tumors, and inflammatory conditions affecting the eye. The bleeding occurs when these conditions damage the delicate blood vessels in and around the retina, allowing blood to leak into the normally clear vitreous gel. Symptoms typically include sudden appearance of floaters, vision loss, or seeing reddish tint. Immediate medical attention is necessary as some underlying causes can lead to permanent vision loss if not treated promptly, as highlighted in studies on retinal vein occlusions 1 and diabetic retinopathy 1. It is essential to prioritize the patient's morbidity, mortality, and quality of life when managing posterior vitreous hemorrhage, considering the potential for severe visual impairment and the need for prompt treatment, as emphasized in the preferred practice patterns for posterior vitreous detachment, retinal breaks, and lattice degeneration 1.
From the Research
Causes of Posterior Vitreous Hemorrhage
- Posterior vitreous detachment with or without retinal breaks is a common cause of vitreous hemorrhage, including posterior vitreous hemorrhage 2, 3, 4
- Proliferative diabetic retinopathy is another major cause of posterior vitreous hemorrhage 2, 3, 5
- Trauma can also lead to posterior vitreous hemorrhage 2, 3
- Less common causes include vascular occlusive disease, retinal arterial macroaneurysm, hemoglobinopathies, age-related macular degeneration, intraocular tumors, and others 2, 3, 6, 4
Pathological Mechanisms
- Disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source are associated with the development of vitreous hemorrhage, including posterior vitreous hemorrhage 3, 6
- Bleeding from diseased retinal vessels, bleeding from abnormal new vessels, or extension of hemorrhage through the retina from other sources can also cause posterior vitreous hemorrhage 6
Diagnosis and Management
- Diagnosis of posterior vitreous hemorrhage requires a thorough history taking and clinical examination, including investigations such as ultra-sonography 3, 6
- Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery, with pars plana vitrectomy remaining the cornerstone of management 3, 5