Here’s Blood in Your Eye!

Blood in your eye can mean many things to different people.  The most common “blood” is the sudden appearance of fire engine red blood on the outside of the.  It is called a subconjunctival hemorrhage.  It is usually scary, painless, ugly and benign.  As a black and blue bruise, it will clear in about 1-2 weeks.

I am talking about blood inside your eye.

Vitreous Hemorrhage – In patients with diabetic retinopathy, the sudden appearance of “floaters” can be signs of a vitreous hemorrhage.  Patients with proliferative diabetic retinopathy, by definition, have developed neovascularization, or abnormal blood vessels, somewhere inside the eye.  Most commonly, the neovascularization, is found on the surface of the retina, but can also be present on the optic nerve and iris. These blood vessels are very fragile and may break open and bleed causing blood to accumulate in the vitreous.

A vitreous hemorrhage can cause dramatic loss of vision as it physically may block light from hitting the retina.  It is not an emergency despite the significant loss of vision.  As long as the retina is attached, the hemorrhage may be observed for weeks or even months.  It causes no damage, just anxiety.

A vitreous hemorrhage may also be caused by a tear in the retina.  Retinal tears may occur in anyone.  So, in diabetic patients with a vitreous hemorrhage……….As long as the retina is attached and without a tear, we can wait.

Laser treatment to the retina is the antidote for proliferative diabetic retinopathy.  If there is too much blood in the vitreous, it may not be possible to laser the retina.  Sometimes we can wait for the hemorrhage to absorb and then treat with laser in the office.  Other times, the hemorrhage does not clear and we may choose to operate, that is, perform a “vitrectomy.”  In this case, the blood is mechanically removed and then the retina is treated with laser during the operation.

Sub-Retinal Hemorrhage – Blood underneath the retina is called a sub-retinal hemorrhage.

A sub-retinal hemorrhage may occur in patients with wet macular degeneration.  Abnormal blood vessels,  called choroidal neovascularization, may develop within the layers of the retina in “wet” macular degeneration.  Patients with “wet” macular degeneration, by definition, have developed neovascularization underneath the retina.

The blood underneath the retina, too, is benign.  It does no harm to the retina. The neovascular tissue; however, may be causing some damage and efforts are made to quickly arrest further progression of the abnormal blood vessels.

Once the presence of neovascularization is confirmed underneath the retina by a fluorescein angiogram, the treatment of choice may be anti-VEGF medications such as Avastin®, Lucentis® or Macugen®.

“Randy”

Randall V. Wong, M.D.
www.TotalRetina.com
Ophthalmologist, Retina Specialist

Tagged as: anti-VEGF, Bevacizumab, Choroidal neovascularization, Conditions and Diseases, Diabetic retinopathy, Eye Disorders, Macular Degeneration, neovascularization, Ranibizumab, Retina, vitreous hemorrhage