What is diabetic vitreous hemorrhage?
Diabetic vitreous hemorrhage means blood has leaked into the vitreous gel of the eye as a result of diabetic damage. The vitreous is a clear gel that fills the center of the eye and helps to hold the retina in place against the eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has many fine blood vessels that may become damaged from diabetes leading to bleeding into the vitreous. Blood in the vitreous (vitreous hemorrhage) interferes with vision.
What symptoms does diabetic vitreous hemorrhage cause?
Diabetic vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. They are more noticeable when looking at a blank surface and may interfere with the good vision in the fellow eye. If vitreous hemorrhage is severe, the vision may be severely limited. Patients may only see shadows or light, but no details.
Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. Flashes are caused by vitreous gel pulling on the retina with eye movement. They may be seen in the setting of diabetic vitreous hemorrhage, but are not worrisome in themselves.
Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some people with these symptoms, the retina may tear and detach resulting in loss of vision. Therefore, these new symptoms warrant prompt evaluation.
What causes diabetic vitreous hemorrhage?
Diabetes can cause vitreous hemorrhage by weakening the blood vessels in the retina and by causing the vitreous gel to shrink and pull on the retinal vessels. Aging also causes changes in the vitreous gel and can cause it to pull on the retina. In any given patient with diabetes, both weakened retinal blood vessels, as well as tugging on the blood vessels from the vitreous play a role in causing vitreous hemorrhage. However, in some eyes weakened blood vessels may be the main reason and in other eyes the main reason for bleeding may be tugging from the vitreous. This is an important issue as diabetic vitreous hemorrhage may be treated differently depending on its underlying cause.
How is diabetic vitreous hemorrhage treated?
The most important step is to have a thorough eye examination with ultrasonography. The ultrasound machine uses sound waves to safely and effectively “look through” the blood in the vitreous to see if the retina is attached. If a retinal detachment is found, surgery is required in an attempt to repair it. If no retinal detachment is found on ultrasound exam, your doctor may allow the vitreous hemorrhage to clear on its own with time. The ultrasound exam may be repeated periodically to assure the retina remains attached. If the hemorrhage does not clear on its own, vitrectomy surgery as a one-day surgery in the hospital operating room may be considered. The amount of visual return depends on several factors including the health of the underlying retina.
In an effort to prevent additional bleeding, the underlying diabetic retinopathy may be treated with medication injections (e.g. Avastin, Lucentis, or Eylea) into the eye. These injections can usually be given without significant pain by using anesthetics. The injections reduce the risk of future bleeding, but do not hasten the clearing of the bleeding that has already occurred. These medication injections may be especially important if no previous laser (or insufficient laser) has been given for diabetic retinal damage (diabetic retinopathy) prior to the vitreous hemorrhage. Medication injections do not help with tugging on the retinal blood vessels by the vitreous. Indeed, in rare cases the injections may increase the tugging. Therefore, if tugging from the vitreous is determined to be the main factor in causing the diabetic vitreous hemorrhage, injections may not be used. Instead, vitrectomy surgery is more effective at relieving the tugging.
Once the vitreous hemorrhage has cleared over time with observation or with vitrectomy surgery, laser is often used to stabilize the retinal blood vessels that have been weakened from diabetes. This helps reduce the chances of reoccurrence of vitreous hemorrhage in the future.
What should I be on the lookout for?
After examination or treatment for a vitreous hemorrhage, you should notify your doctor if you have a burst of new floaters, a loss of side vision, or pain. Sometimes, retinal tears or a retinal detachment occur at a later date after the examination.
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