Vitreous Bleed / Haemorrhage
What is a vitreous bleed? What are its symptoms?
A vitreous hemorrhage is when there's bleeding inside the eye, specifically in the jelly-like substance called the vitreous. This can reduce or affect vision because blood blocks the transmission of light into the eye.
The most common symptom is sudden floaters - those little specks or strands that seem to drift across your field of vision. You might also see flashes of light and your vision could become blurry.
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What causes a vitreous bleed?
There are many causes, with the more common ones being a retinal tear, poorly controlled diabetes or high blood pressure.
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Is a vitreous bleed dangerous?
A vitreous bleed in itself is not dangerous as blood can be easily cleared by surgery (a vitrectomy). However, the underlying cause will need to be treated. For example, if a retinal tear has caused the bleed, laser will need to be performed to prevent the tear from extending and becoming a retinal detachment.
What is the most likely cause of my vitreous bleed?
The causes are numerous but this table lists the symptoms or conditions that help provide clues about the cause of your bleed. For example, if you have noticed flashes or floaters prior to the bleed, the cause is very likely to be a retinal tear. If you have poorly controlled diabetes, the bleed is likely due to that.
How do you treat a vitreous bleed?
Treatment depends on the underlying cause. Sometimes, the bleeding will clear up on its own, and keeping a close eye on it will be enough. However in more severe cases where the blood is very dense, an operation might be necessary to remove the blood and treat the cause. This will be discussed with you and I am always happy to answer any questions from you or your loved ones.
If surgery is required, the operation is called a vitrectomy. I would describe this as using a specialised “vacuum cleaner” to remove the blood which is mixed with the jelly within the eye. Once the blood is cleared and the view is good, I will be able to ascertain the cause of the bleed and treat it. For example, if there was a retinal tear, I would use a microlaser to seal of the tear to stop it from progressing.
What can I expect from surgery? How long will I need to recover?
A vitrectomy for a vitreous bleed can vary in duration from 30 mins to 2 hours, depending on the cause. A retinal tear causing a bleed typically can be treated under 30 mins, however a complex diabetic bleed will require a longer operation. During the procedure, patients are comfortably positioned on their back, administered a relaxing medication through a drip, and subsequently provided with local anesthesia to ensure the eye remains numb. Throughout, you will remain conscious, surrounded by the soothing backdrop of background music and the cheerful banter of our dedicated theatre staff. Before you know it, the surgery will have concluded!
Following the procedure, your eye will be gently padded with gauze and shielded with a clear plastic cover. I will personally remove these the next day. It's worth noting that I often introduce a small amount of air into your eye, which may cause temporary blurriness during the initial week. Many patients find it intriguing to observe a gradual decrease in this effect, akin to a "spirit level," as the air naturally dissipates over time. Subsequent to this adjustment period, your vision should return to its usual state, now free from the bothersome bleed!
You should find yourself able to resume your regular activities and work within approximately 2 week’s time. However, I would recommend refraining from activities such as swimming or those that carry a risk of introducing dirt or dust into the eye for at least two weeks post-surgery. This precaution will help ensure a smooth and uncomplicated recovery process.
It is done as a day procedure, so you will need to have someone to take you home after.
Are there any risks of surgery?
Yes, as with any surgical procedure (or even daily activities such as driving), there is always a chance that complications can happen. Fortunately however, the risks of serious complications such as an infection inside the eyeball (endophthalmitis) are very low - the risk of this is approximately 1 in 3000 (0.03%). The other way of viewing it is that if surgery is not performed, there is a 100% chance of no improvement and very likely worsening of vision over time.
Click here for a more detailed explanation of the risks of surgery.