Vitreous haemorrhage 

This may occur spontaneously or after trauma. The main causes of spontaneous vitreous 
haemorrhage are: posterior vitreous detachment with or without retinal breaks, proliferative
diabetic retinopathy, central retinal vein occlusion and subretinal neovascular membrane in 
age-related macular degeneration with breakthrough bleeding.

Presentation:

  • Sudden onset of floaters causing impaired vision
Examination:
  • Depending on the severity of the haemorrhage, the view may be impossible with 

    • a direct ophthalmoscope (it is then important to examine the good eye which may 
    provide clues such as in diabetes mellitus).
Management:
  • Refer within 24 hours
  • In the casualty, the ophthalmologists will examine the eye for any posterior vitreous 

    • detachment and diabetic changes.
  • An ultrasound is often performed if the view is poor to exclude a retinal detachment
  • These patients require close observation until the cause has been established or treated
Figure 1
This diabetic patient complains of blurred right vision. Fundoscopy
reveals a subhyaloid haemorrhage (haemorrhage between the retina
and the vitreous). Note the haemorrhage has a fluid level (which is
typical of subhyaloid haemorrhage) and the presence of previous laser 
photocoagulation scars. This patient certainly has new vessels and 
requires further laser photocoagulation.
2 
2
Figure 2
A patient with severe diabetic retinopathy showing the presence of new vessels at
the disc. Without treatment in the form of photocoagulation, these vessels invariably 
bleed and cause vitreous haemorrhage.
b
Figure 3
Another eye with diabetic retinopathy. The new vessels are at the periphery of 
the retina. Again without treatment, it can cause visual loss through haemorrhages.
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