What are the signs of bleeding after photocoagulation?

Signs of Bleeding After Photocoagulation

The primary signs of bleeding after photocoagulation include vitreous hemorrhage, retinal hemorrhage, preretinal hemorrhage, choroidal hemorrhage, and subretinal hemorrhage, which may manifest as sudden vision loss, new floaters, pain, or redness in the eye. 1, 2

Common Signs and Symptoms of Post-Photocoagulation Bleeding

Immediate Signs (Hours to Days)

• Sudden decrease in vision - Most critical and common sign requiring immediate attention
• New floaters or flashes - Indicates possible vitreous hemorrhage
• Pain and redness in the eye - May indicate complications including bleeding
• Hyphema - Blood in the anterior chamber visible as a fluid level or diffuse redness 3

Location-Specific Signs

• Vitreous hemorrhage:

  • Sudden appearance of numerous dark floaters
  • Cloudy or hazy vision
  • Possible red tint to vision

• Subretinal hemorrhage:

  • Decreased central vision (especially if near macula)
  • Visual distortion
  • May develop within one month of treatment 4

• Choroidal hemorrhage:

  • Severe pain
  • Significant vision loss
  • Possible elevated intraocular pressure 2

Risk Assessment and Monitoring

High-Risk Patients

• Patients on anticoagulant therapy
• History of bleeding disorders
• Poorly controlled hypertension
• Diabetic patients with proliferative retinopathy

Monitoring Protocol

• Immediate post-procedure assessment for any signs of bleeding
• Follow-up examination within 1-2 weeks of photocoagulation
• Regular monitoring with:
  • Visual acuity testing
  • Undilated slit-lamp biomicroscopy
  • Pupillary assessment
  • IOP measurement
  • Stereoscopic examination of the posterior pole 1

Management Algorithm for Suspected Bleeding

1. For minor bleeding signs:

   • Close observation
   • More frequent follow-up appointments
   • OCT imaging to assess extent of hemorrhage

2. For significant bleeding with vision impact:

   • Immediate ophthalmology referral
   • Consider anti-VEGF injections for complications like macular edema
   • Follow-up OCT imaging at 1 month after treatment 1

3. For severe bleeding (e.g., large vitreous hemorrhage):

   • Urgent ophthalmological intervention
   • Possible surgical management if bleeding doesn't resolve

Prevention and Patient Education

• Instruct patients to report immediately:

  • Any sudden decrease in vision
  • New or increased floaters
  • Eye pain or redness
  • Visual field defects

• Advise patients to:

  • Avoid strenuous activity for 1-2 weeks after photocoagulation
  • Maintain good blood pressure control
  • Continue prescribed anticoagulants unless specifically instructed otherwise

Special Considerations

• Bleeding risk is higher with more extensive treatments like panretinal photocoagulation compared to focal treatments
• Patients with retinal vein occlusions may require dense peripheral panretinal photocoagulation to prevent neovascularization, but should be monitored closely for bleeding complications 5
• Hemodynamic instability (increased heart rate, decreased blood pressure) may be the first sign of significant blood loss in rare cases of severe hemorrhage 5

Remember that while bleeding complications can occur after photocoagulation, they are relatively uncommon, and the benefits of preventing severe vision loss from conditions like diabetic retinopathy or retinal vein occlusions generally outweigh these risks.