Causes of Vitreous Hemorrhage

Eye vitreous hemorrhage occurs when blood leaks into the vitreous humor—the clear, gel-like substance that fills the central cavity of the eye. This condition can significantly impair vision, causing floaters, blurred or hazy vision, shadows, or even sudden, painless vision loss depending on the volume and location of the bleed.

The most common underlying cause is proliferative diabetic retinopathy, where abnormal new blood vessels grow on the retina or optic disc and are prone to rupture due to their fragile structure. Other frequent etiologies include posterior vitreous detachment—especially when it involves traction on retinal vessels—and retinal tears or detachments. Trauma, whether blunt or penetrating, is another major contributor, particularly in younger patients.

Less common but clinically important causes include retinal vein occlusion, sickle cell retinopathy, age-related macular degeneration with choroidal neovascularization, and intraocular inflammation such as intermediate or posterior uveitis. Rarely, vitreous hemorrhage may signal an intraocular tumor, such as retinoblastoma in children or melanoma in adults, necessitating thorough diagnostic evaluation.

Diagnosis relies on comprehensive ophthalmic examination—including visual acuity testing, intraocular pressure measurement, and slit-lamp biomicroscopy—often supplemented by B-scan ultrasonography when media opacity prevents direct visualization of the retina. Optical coherence tomography (OCT) and fluorescein angiography may further clarify associated retinal pathology.

Management depends on the cause, severity, and duration of hemorrhage. Small, nonprogressive bleeds may resolve spontaneously over weeks to months. However, persistent or recurrent hemorrhage—particularly if associated with underlying retinal ischemia, neovascularization, or detachment—typically warrants intervention. Treatment options include intravitreal anti-VEGF injections, panretinal photocoagulation for neovascular disease, and pars plana vitrectomy to remove blood and address structural complications.