A vitreous hemorrhage may be caused by a retinal tear. Sometimes there is so much blood in the eye that direct examination is impossible and we can only guess at the most likely cause. It is the most difficult situation for me to handle as a doctor.
Patients lose significant vision as the blood in the middle of the eye physically blocks all light from hitting the retina. While this is usually not permanent visual loss, the blood makes it difficult to make a definitive diagnosis as it can be impossible to see the retina.
Normally, without blood in the eye, a retinal tear may be easily diagnosed and treated with laser.
While there are other causes of vitreous hemorrhage, such as diabetic retinopathy, retinal vascular disease and others. Still, a retinal tear causing the vitreous bleeding is quite likely.
A retinal tear can cause a retinal detachment. A retinal detachment is potentially blinding.
In cases of vitreous hemorrhage, the patient cant’ see “out” and I can’t see “in.” My ability to examine the eye is hindered.
Options at this point are to observe (i.e. do nothing). Observing the eye is okay as the blood is doing no harm. But what if there is a retinal tear? A retinal detachment could occur if there is an undiagnosed retinal tear.
Other tests, such as an ultrasound can often detect a large tear, but it is not as good as directly examining the eye. Operating to remove the blood to facilitate proper examination is an option, too.
What Does This Mean?
I am getting older, more aggressive, but smarter.
As I have aged, i.e. gained more experience, I have become more comfortable operating in these cases. When I was younger, I would often hesitate because I was uncomfortable offering surgery in a situation where surgery might not be necessary, but I’ve learned (through experience) that watching a waiting can be more problematic.
Most of the time I recommend operating to at least remove the blood and confirm a diagnosis. The risks of modern vitrectomy are quite low, while the risk of a retinal detachment occurring while we are waiting is quite possible.
Vitrectomy surgery is usually performed as an outpatient. If a tear is indeed present, it can be treated simultaneously.
At the very least, a diagnosis can be made and a potentially blinding condition avoided.