Vitreous Hemorrhage: Causes and Treatment Options
What Is a Vitreous Hemorrhage
A vitreous hemorrhage refers to any bleeding that occurs within the vitreous cavity of the eye. The severity can range from a few scattered blood cells that cause mild visual disturbances to a dense bleed that blocks vision almost entirely.
The vitreous is a transparent, jelly-like substance that fills roughly 80 percent of the eye's interior volume. It helps maintain the eye's round shape and allows light to pass cleanly through to the retina, the light-sensitive tissue at the back of the eye. Because the vitreous is normally clear, even a small amount of blood within it can interfere with the way light reaches the retina and reduce visual clarity.
Blood typically enters the vitreous from damaged or abnormal retinal blood vessels. In some cases, normal vessels tear during a posterior vitreous detachment, while in others, fragile new vessels created by conditions like diabetic retinopathy rupture and bleed. Less commonly, bleeding may originate from the choroid, a layer of blood vessels beneath the retina, or from trauma that disrupts healthy vessels.
Certain groups face a higher likelihood of developing vitreous hemorrhage. Risk factors include:
- Diabetes, particularly when diabetic retinopathy is present
- A history of retinal tears, retinal detachment, or retinal vein occlusion
- Age-related posterior vitreous detachment, which becomes more common after age 50
- Eye trauma or recent intraocular surgery
- Blood-thinning medications, which may increase the severity of bleeding
What Causes Bleeding into the Vitreous
Many different conditions can lead to vitreous hemorrhage. Identifying the underlying cause is essential because treatment depends not only on clearing the blood but also on addressing the source of the bleeding.
Diabetic retinopathy is the most common cause of vitreous hemorrhage in adults. When diabetes damages the small blood vessels of the retina over time, the eye may respond by growing new, abnormal blood vessels in a process called neovascularization. These new vessels are fragile and prone to bleeding, sometimes without warning. Proliferative diabetic retinopathy, the advanced stage of the disease, carries the highest risk of vitreous hemorrhage.
As part of normal aging, the vitreous gel gradually shrinks and separates from the retina in an event known as posterior vitreous detachment (PVD). Posterior vitreous detachment occurs in the majority of people by age 70 and is the most common cause of new floaters (American Academy of Ophthalmology). However, if the vitreous tugs on a retinal blood vessel during separation, it can tear the vessel and release blood into the vitreous cavity. Approximately 10 to 15 percent of patients with symptomatic posterior vitreous detachment are found to have a retinal tear at the time of examination (American Society of Retina Specialists). A retinal tear caused by PVD requires prompt evaluation because it can progress to a retinal detachment if left untreated.
A retinal vein occlusion happens when a vein that drains blood from the retina becomes blocked. The resulting backup of blood pressure can cause existing vessels to leak or stimulate the growth of new abnormal vessels that bleed easily. Both branch and central retinal vein occlusions can lead to vitreous hemorrhage, particularly when neovascularization develops as a complication.
Blunt or penetrating eye injuries can rupture retinal or choroidal blood vessels and produce a vitreous hemorrhage. Additional causes include:
- Sickle cell retinopathy, which creates abnormal vessel growth similar to diabetic eye disease
- Age-related macular degeneration with breakthrough bleeding from choroidal neovascularization
- Terson syndrome, vitreous hemorrhage associated with bleeding around the brain
- Blood disorders or anticoagulant therapy that prolongs bleeding
Symptoms of Vitreous Hemorrhage
The symptoms you experience depend on how much blood has entered the vitreous and how quickly the bleeding occurred. Vitreous hemorrhage is typically painless, which means visual changes are often the first and only sign.
New floaters are one of the earliest signs of a vitreous hemorrhage. You may notice small dark spots, cobweb-like strands, or a shower of tiny specks drifting across your field of vision. These floaters are shadows cast by blood cells or clots suspended in the vitreous. A sudden increase in the number or size of floaters, especially when accompanied by flashes of light, warrants prompt evaluation by a retina specialist.
As more blood accumulates, your vision may become hazy, as though you are looking through a red or dark filter. A mild hemorrhage might only cause slight blurring, while a dense bleed can reduce vision to the point where you can perceive only light and shadow. Some patients describe their vision as looking through a reddish or smoky haze, particularly in the morning after blood has settled overnight and then re-disperses with eye movement.
A small vitreous hemorrhage may produce only a few new floaters and minimal visual disruption. In many of these cases, the blood gradually absorbs on its own over weeks to months. A severe hemorrhage, on the other hand, can obscure the retina completely, making it difficult for your doctor to examine the back of the eye and requiring more urgent intervention. Regardless of severity, any new onset of floaters, flashes, or vision darkening should be evaluated promptly to rule out a retinal tear or detachment.
Is Vitreous Hemorrhage a Medical Emergency
While vitreous hemorrhage itself is not always an emergency, the conditions that cause it can be sight-threatening. Because it is impossible to determine the cause without a thorough examination, any sudden change in vision should be treated with urgency.
You should contact our retina specialists or seek urgent eye care if you experience a sudden shower of new floaters, flashes of light in your peripheral vision, a dark curtain or shadow spreading across your visual field, or a rapid decline in vision. These symptoms can indicate a retinal tear, retinal detachment, or active bleeding that requires timely treatment to prevent permanent vision loss.
During an urgent visit, your doctor will dilate your pupils and perform a detailed examination of the retina using specialized lenses and instruments. If blood in the vitreous is too dense to see through, an ultrasound of the eye (B-scan ultrasonography) can determine whether the retina is still attached and help identify the source of bleeding. Optical coherence tomography (OCT) and other imaging may be used once the blood clears enough to visualize the retina directly.
If you develop symptoms and are waiting to be seen, keeping your head elevated, even while sleeping, can encourage blood to settle toward the bottom of the eye and away from your central line of sight. Avoid strenuous activity, heavy lifting, and blood-thinning medications such as aspirin or ibuprofen unless directed otherwise by your physician. These steps will not treat the hemorrhage, but they may help limit further bleeding and improve comfort while you await evaluation.
Frequently Asked Questions
Diagnosis begins with a comprehensive dilated eye exam. Our retina specialists use indirect ophthalmoscopy and slit-lamp biomicroscopy to examine the vitreous and retina. When dense blood blocks the view, B-scan ultrasonography provides a real-time image of the retina's position and can detect retinal tears, detachments, or masses behind the hemorrhage. Once enough blood clears, additional tests such as fluorescein angiography or OCT may be performed to identify the underlying cause.
In many cases, mild to moderate vitreous hemorrhage does resolve without surgical intervention. The body gradually reabsorbs the blood from the vitreous cavity over a period of weeks to several months, depending on the volume of bleeding. During this time, your retina specialist will monitor the eye closely to ensure the retina remains healthy and to watch for rebleeding. If the underlying cause, such as a retinal hemorrhage from vein occlusion, is identified and treated, the chances of spontaneous clearing improve.
Vitrectomy, a surgical procedure that removes the vitreous gel along with the blood, is recommended when the hemorrhage does not clear on its own within a reasonable timeframe, when it is too dense to allow examination of the retina, or when an associated retinal detachment is suspected. Vitrectomy may also be performed urgently in cases of active proliferative diabetic retinopathy with tractional retinal detachment. During the procedure, the vitreous is replaced with a clear saline solution or a gas bubble, depending on whether additional retinal repair is needed.
Vitreous hemorrhage is most frequently linked to proliferative diabetic retinopathy, posterior vitreous detachment with or without a retinal tear, and retinal vein occlusion. Other associated conditions include sickle cell retinopathy, wet age-related macular degeneration, ocular trauma, retinal macroaneurysm, and blood dyscrasias. Identifying the specific cause is critical because treatment strategies differ significantly depending on the underlying disease.
The clearing time varies widely based on the amount of blood and the patient's overall eye health. A small hemorrhage may noticeably improve within two to four weeks, while a larger bleed can take three months or longer to resolve. Your retina specialist will schedule regular follow-up visits during this period to track progress and decide whether observation can continue or surgical intervention is warranted.
Follow-up care focuses on monitoring for rebleeding, ensuring the retina remains attached, and managing the condition that caused the hemorrhage. You can expect frequent eye exams in the weeks following diagnosis, with the interval between visits gradually lengthening as the blood clears and the eye stabilizes. If diabetic retinopathy is the cause, laser treatment (panretinal photocoagulation) or anti-VEGF injections may be administered to reduce the risk of future bleeding. Patients with retinal tears typically undergo laser or cryotherapy to seal the tear and prevent detachment.
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