Clinical features

• symptoms of vitreous hemorrhage are
  • painless floaters
    • these are unilateral
    • are caused by mild hemorrhage
    • may be described as
    • floaters,cobwebs, haze, shadows ,a red hue
  • visual loss
    • occurs as a result of more significant hemorrhage
      • visual acuity may reduce
      • visual fields can be restricted
      • scotomas may be associated
      • vision is sometimes poorer in the mornings
        • this happens when blood collects at the back of the eye
• points to look for in the history
  • ocular trauma
  • eye surgery
  • diabetes mellitus
  • sickle cell anemia
  • leukemias
  • diseases of the carotid artery
  • high myopic refractive error
• examination should include
  • indirect ophthalmoscopy with scleral depression
  • gonioscopy
  • measurement of intra ocular pressure
  • B-scan ultrasonography
  • dilated fundoscopy of the other eye
    • may give hints as to the aetiology (e.g. proliferative diabetic retinopathy)
• vitreous haemorrages may occur in many patterns
  • nondispersed vitreous hemorrhage
    • the retina may be visible
    • the location may be known
    • the source of the lesion may be found out
  • preretinal hemorrhage
    • seen in the subhyaloid space
    • frequently seen as boat-shaped lesions
    • occurs between the posterior hyaloid and the internal limiting membrane
    • this subsides gradually
  • dispersed vitreous hemorrhage
    • this has no clear margins
    • small lesions may be seen as few red blood cells
    • large lesions may obscure the poterior pole

Reference:

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