A vitreous hemorrhage may be caused by a retinal tear. Sometimes there is so much blood in the eye that direct examination is impossible and we can only guess at the most likely cause. It is the most difficult situation for me to handle as a doctor.
Patients lose significant vision as the blood in the middle of the eye physically blocks all light from hitting the retina. While this is usually not permanent visual loss, the blood makes it difficult to make a definitive diagnosis as it can be impossible to see the retina.
Normally, without blood in the eye, a retinal tear may be easily diagnosed and treated with laser.
While there are other causes of vitreous hemorrhage, such as diabetic retinopathy, retinal vascular disease and others. Still, a retinal tear causing the vitreous bleeding is quite likely.
Retinal Tears Cause Retinal Detachments
A retinal tear can cause a retinal detachment. A retinal detachment is potentially blinding.
In cases of vitreous hemorrhage, the patient cant’ see “out” and I can’t see “in.” My ability to examine the eye is hindered.
Options at this point are to observe (i.e. do nothing). Observing the eye is okay as the blood is doing no harm. But what if there is a retinal tear? A retinal detachment could occur if there is an undiagnosed retinal tear.
Other tests, such as an ultrasound can often detect a large tear, but it is not as good as directly examining the eye. Operating to remove the blood to facilitate proper examination is an option, too.
What Does This Mean?
I am getting older, more aggressive, but smarter.
As I have aged, i.e. gained more experience, I have become more comfortable operating in these cases. When I was younger, I would often hesitate because I was uncomfortable offering surgery in a situation where surgery might not be necessary, but I’ve learned (through experience) that watching a waiting can be more problematic.
Most of the time I recommend operating to at least remove the blood and confirm a diagnosis. The risks of modern vitrectomy are quite low, while the risk of a retinal detachment occurring while we are waiting is quite possible.
Vitrectomy surgery is usually performed as an outpatient. If a tear is indeed present, it can be treated simultaneously.
At the very least, a diagnosis can be made and a potentially blinding condition avoided.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia
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I had th epiretinal membrane done on my right eye on oct last year and cataract developed one month later (and my wavy vision had not much improvement ) ,I had the cataract surgery done this year on oct 2011 ,and when my blur vision recovered ,I notice of double and wavy vision . Now I am wearing glasses with prism on my right eye (v-prism 2.00 up ) . What is the caused of double vision ? will it recovered after wearing the prism len for sometimes ?
I have just had the 7th surgery on my right eye for repeated retinal detachments. During my last surgery for retinal detachment it was discovered that I also had a hole in the macula and a retinal tear. My surgeon repaired all three with vitrectomy and endo laser and he placed silicone oil in my eye in hopes that the membranes that keep pulling my retina loose, will not form. I have been dealing with this since February of this year and have used Prednisone 1% drops since then as well as antibiotic drops and ointment after each surgey. He has continued to do his best torestore my vision but at this point I feel that if this surgery doesn’t work I cannot endure another surgery. I have adapted to living without vision in my right eye and feel that perhaps that is what I will have to live with. Will my eye remaing normal looking if my vision is not restored? Is there a risk of losing my eye completely? Have you heard of other patients that have had this many surgeries and finally get their vision back?
Dear Joycelyn,
I have no idea why you have double vision after the surgery. I would pursue this with your doc.
Sorry.
Randy
Dear Patrice,
Losing all vision is a possibility. Understand I don’t know your exact situation and I can not examine you, but rarely do eyes with this many retinal detachments see well.
It is possible that you could lose the eye if the retina is not detached. The condition is called phthisis bulbi. This, however, would happen very gradually.
Randy
Hello Doc,
Thank you for your efforts in running this blog. Very useful and informative.
I had a retinal detachment 6 months ago, probably due to a tear that progressed over 2-3 months to upper 1/3rd vision loss. A vtreoctomy with gas and scleral buckle was performed first and due to lot of retinal bleeding (not sure if redetached retina) a second one was done after 20 days with silicone oil and the eye lens removed. The original detachment had just about reached macula.
Retina is now attached and flat ever since. My vision in the affected eye is blurry and little distorted. It is also restricted (i.e. I have only central vision and no peripheral vision). My other (good) eye has good vision but it has something on the retina that one doc called a “hole”. But my eye surgeon says it is a pigmentation and no need to worry abt now.
I would really be thankful if you answer my following questions
1) What is the reason for loss of peripheral vision after surgery? Will this be permanent?
2) Should I be worried abt the hole/pigmentation in the good eye retina? If yes what should I do?
3) Should I get the oil removed if my doc says so? Or should I first opt for a contact lens (to replace my natural lens which was removed) and see how that works. If it is acceptable vision maybe I will keep the oil as long as I can tolerate it.
4) I am a healthy 39 yr old male, not diabetic, myopic in both eyes (about -4.0 each). What could be the cause of the retinal tear?
5) This may be interesting to you – I used to do regular Yoga and heavy Pranayama (breathing exercises). I read online that there is some connection between these, which can cause increased eye pressure and retinal tears. Is this true?
thanks again for your help and wish you a very happy new year,
Sid,
Boston, MA
Dear Sid,
1. Can’t tell from your description, could be from blood, could be from huge refractive change from the oil, could be from having no lens, could be from the retinal detachment.
2. If it’s pigmentation as your retinal surgeon suggested, then usually nothing to worry about, but let him/her follow up on that area.
3. Get the oil removed first…when your doc suggests. Vision with contact lens and silicone oil probably not going to be very good. Related to the optical differences between oil and water.
4. Tears can happen in anyone.
5. Not to my knowledge.
Happy New Year!
r
Hi. Your blog is very helpful to me as my son has Sticklers Syndrome and has had many retinal detachments. He lost his right eye and is now having problems with a hemorrhage in his left vitreous. He’s had 3 detachments in that eye, but the surgeries at Wilmer were successful as he’s not had any problems in 4 years. Until a year ago when the hemorrhage started blurring his vision severely. The retina doc that he sees here in newport news doesn’t do an ultrasound. Don’t you almost agree that it should be done in order to see the retina where the blood is? Thanks so much! Valerie
Dear Valerie,
No. An ultrasound is indicated if you can’t visually confirm the retina is attached. If you can’t see the retina, then a B-Scan may be needed.
Thus, it is possible that enough of the retina was visible in Newport News, hence an ultrasound would not be necessary.
Did this help?
r
Dear Dr. Wong
5 days ago I had a vitrectomy in my left eye to repair a tear in my retina which caused detachment. A gas bubble was inserted into my eye and I have been laying on my right side since the op as instructed by the doctors. When laying down, the parapherial vision on the left side is becoming clear, and when I stand the top half of my vision is relatively clear. The other half of my vision is like looking through a dark jelly (which I had incorrectly assumed until now was the gas!), through which it is very hard to make out any objects and looking through it instantly makes me seasick. What is confusing me is that based on how the gas should rise, it seems that I see ok where the gas is but can’t see at all where there is not any gas. Is this a normal part of the recovery at this stage, or do I need to get into the hospital immediately if this could indicate a complication? Thank you
Chris
Chris,
This is all normal. The respective portion of the retina sees the opposite field. For example, when you are standing up, the gas rises to the top of your eye. The top portion of your retina “sees” below, or inferiorly, and is blocked by the gas…hence, the vision below is poor.
Make sense?
If you think about it, this “reversal” is the only way we could possibly have so much peripheral vision through a small 2-3 mm pupil.
Randy
Thanks doctor, that makes sense and is a relief. The gas is getting noticeably smaller each day, and I’m very hopeful that this procedure will have removed most if not all of the floaters in my eye in the months before the detachment. With all the refracting lights from the gas bubble its still hard to tell how this will turn out. I really appreciate you sharing your knowledge on this. – chris
Dear Dr. Wong,
Last May, 2011, I had a retina tear in my left eye. I am a nearsighted both eye 3.00, I had laser surgery at once but in the left side only. However, after a month, I had Vitreous hemorrhage on the same eye, ultra sound and ultra sonography found no detachment of retina, my problem now is my Vitreous Hemorrhage.
My question are the ff.
1. can i have Vitrectomy Surgery now?
2. what are the risk factors?
3. what are the rate of success for a vitrectomy surgery?
4. other informations?
-Mr. Liao, 53 years of age, from the Philippines
Thank you so much! Hoping that you may reply the questions that had been asked.
Dear Mr. Liao,
As I said on my FP Page, if you still have blood in your vitreous, a vitrectomy may indeed be helpful. Obviously, the resultant vision will depend on the health of your retina and other structures.
The major risk of any intraocular surgery are blinding infection or retinal detachment. Both are extremely unlikely.
Look forward to hearing from you.
Randy
Dear Doctor Wong,
Thanks for your reply, my Retina Doctor did not advice for a Victrectomy Surgery,
because he is hoping that the Vitreous Clots will clear on its’ on, or the body will absorb on it’s own, waiting for several months to absorb, besides its not causing Severe Vision lose. I had a full background vision but its not clear yet, my problem is the Vitreous Clots that is very disturbing and bother my sight often, because the Vitreous move fast and spread like a thin line or a thin cloud that make it blurred. Hope you can advice me to my question?
1. Can my Vitreous Clots still absorb on its own? Will the body absorb it too?
2. How long will it take too fully absorb in my Vitreous?
3. In my case, will you now advice A Vitrectomy Surgery or wait for a longer time?
4. Are bleeding, infection, progression of CATARACT and Retinal Detachment always a Risks and Complication in a Vitrectomy Surgery?
Thank you So much! And more Power.
Mr. Liao,
1. I doubt they will if they have yet to do so.
2. It may not absorb.
3. I would advise, as I did before, that you consider a vitrectomy.
4. Bleeding, infection, and retinal detachment are always a potential risk, but very very slight. Bleeding is usually benign. Infection is rare, at least in the U.S., occurring 1:10,000 or less. Retinal detachment is probably around 1%. If your vitrectomy surgeon is careful, cataract will not likely progress any faster than normal.
Randy
Thank you! Can I ask if you know a Victrectomy surgeon residing here in the Philippines that you would like to recommend?