Age-Wise Etiologies of Vitreous Hemorrhage
The etiology of vitreous hemorrhage varies dramatically by age: in children, trauma (both manifest and occult) accounts for approximately 73% of cases, while in adults, proliferative diabetic retinopathy and posterior vitreous detachment with retinal tears become the dominant causes, with diabetic retinopathy affecting 28.5-40.3% of diabetic patients over age 40. 1, 2
Pediatric Population (Under 18 Years)
Primary Causes in Children
- Trauma is the leading cause, accounting for 73% of all pediatric vitreous hemorrhage cases 1
Non-Traumatic Causes in Children
- Regressed retinopathy of prematurity (ROP) is the most common spontaneous cause, representing 27% of non-traumatic cases 1
- Retinal vasculitis is also seen in pediatric populations 3
Clinical Presentation Patterns
- Younger children typically present with strabismus and nystagmus rather than visual complaints 1
- Older children more commonly report decreased visual acuity 1
- 90.5% of pediatric cases are unilateral 1
Adult Population (Ages 18-65)
Middle-Aged Adults (40-65 Years)
Posterior vitreous detachment (PVD) becomes the dominant mechanism in this age group, typically occurring between ages 45-65 2, 4
- 8-22% of patients with acute PVD symptoms have a retinal tear at initial examination 2, 4
- Two-thirds of patients presenting with PVD-associated vitreous hemorrhage have at least one retinal break 2
- Approximately 88% of breaks occur in the superior quadrants 2
Diabetic Retinopathy in Adults Over 40
- Proliferative diabetic retinopathy affects 28.5-40.3% of diabetic patients over age 40 2
- This represents the general population prevalence of 3.4% for diabetic retinopathy in those over 40 2
- Hispanic populations show higher rates (46.9% in diabetic patients over 40) 2
Other Adult Causes
- Branch retinal vein occlusion is a common cause in middle-aged and older adults 3
- Retinal vasculitis contributes significantly to adult cases 3
- Rhegmatogenous retinal detachment accounts for approximately 25.5% of non-diabetic, non-traumatic cases 5
Elderly Population (Over 65 Years)
Primary Etiologies in the Elderly
In elderly patients, vitreous hemorrhage usually occurs spontaneously rather than from trauma 6
- Vascular lesions account for 32.5% of non-diabetic, non-traumatic cases 5
- Posterior vitreous detachment remains common, though it occurs earlier in men than women 2, 4
- Retinal tears (without detachment) represent 8% of cases 5
Age-Related Conditions
- Age-related macular degeneration with choroidal neovascularization becomes a significant cause 5
- However, visual outcomes are poorest in this group (76% achieve vision below 20/400) 5
- Retinal arterial macroaneurysm is more common in elderly patients 7
- Vascular occlusive disease increases with age 7
Terson Syndrome
- Accounts for 5.5% of non-diabetic, non-traumatic cases 5
- Shows excellent visual outcomes (100% achieve 20/40-20/20 vision) 5
Critical Age-Related Risk Factors
Factors Accelerating PVD Onset
- Myopia causes earlier PVD onset regardless of age 2, 4
- Trauma precipitates PVD at younger ages than typical 2, 8
- Ophthalmic surgical procedures (cataract surgery, intravitreal injections) can trigger PVD 2, 8
Gender Differences
- PVD occurs earlier in men than women across all age groups 2, 4
- Male patients represent 73% of vitreous hemorrhage cases overall 3
Clinical Pitfalls and Caveats
In children, always consider occult trauma and non-accidental injury, particularly when bilateral hemorrhage is present, as shaken baby syndrome accounts for half of bilateral pediatric cases 1
The mean age across all causes is approximately 41.9 years, reflecting the bimodal distribution with peaks in childhood trauma and adult diabetic/PVD-related hemorrhage 3
Visual outcomes are highly etiology-dependent: penetrating trauma yields the poorest outcomes, while regressed ROP and Terson syndrome show the best visual recovery 1, 5
Between 5-14% of patients with initial retinal breaks develop additional breaks during long-term follow-up, emphasizing the need for continued surveillance regardless of age 2