Treatment

• management of vitreous haemorrhage (1)
  • sudden loss of vision is an ophthalmological emergency
  • it requires immediate referral to the eye emergency department
  • retinal detachment should be first excluded as the cause
    • ultrasonography may be necessary to detect a retinal detachment, especially if the posterior segment is not visible
    • if the posterior pole is is not visible(1)
      • bed rest is recomended
      • head of the bed should be kept elevated when sleeping
        • this lets the haemorrhage to resolve to the lower pole
        • superior part of the retina may then be visible
  • once the retina is visualized, the underlying aetiology should be treated early
    • if the retina is attached
      • may be observed as an outpatient (1)
      • can engage in normal day to day living
  • follow up
    • clearing of the vitreous hemorrhage should be monitored
    • this should be done periodically
    • in case of recurrent vitreous hemorrhage
      • referral to a retinal specialist is needed
      • may need vitrectomy

Retinal detachment is an indication for urgent vitrectomy

• other indications for vitrectomy include
  • when the vitreous hemorrhage is not clearing
  • neovascularization of the iris
  • ghost cell glaucoma

Notes:

• retinal breaks are treated with
  • cryotherapy
  • laser photocoagulation
• aspirin and other forms of anticoagulation ( warfarin, clopidogrel) (1)
  • does not worsen the condition
  • can be continued after a vitreous hemorrhage

Reference:

(1) vitreous hemorrhage: diagnosis and treatment, John P. Berdahl, et al, copyright © american academy of ophthalmology, 2007