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Vitreous Hemorrhage: Causes, Symptoms, and Treatment
Who Is at Risk
Vitreous hemorrhage can happen at any age, though the most common causes differ between younger and older adults. Knowing the leading risk factors helps explain why certain patients need especially close monitoring of their retinal health.
Proliferative diabetic retinopathy is the leading cause of vitreous hemorrhage in adults. Chronic high blood sugar damages retinal blood vessels over time, and the eye responds by growing new, fragile vessels that are highly prone to bleeding. Poor blood sugar control significantly increases this risk, making glycemic management a critical part of protecting vision.
As people age, the vitreous gel naturally shrinks and pulls away from the retina, a process called posterior vitreous detachment, or PVD. This becomes more common after age 60. When the vitreous separates, it can tug on retinal blood vessels and cause them to bleed. PVD-related vitreous hemorrhage also carries a meaningful risk of a concurrent retinal tear, which requires urgent evaluation.
Eye trauma is the leading cause of vitreous hemorrhage in people under 40. A direct blow to the eye or head can rupture retinal vessels, even when no external injury is visible. Males are at higher risk in this category. Any significant eye trauma that results in sudden vision changes should be evaluated promptly by a Retina Specialist.
Several other medical conditions are associated with vitreous hemorrhage. Understanding these helps guide both diagnosis and long-term management.
- Retinal vein occlusion, a blockage in the veins draining the retina
- Wet age-related macular degeneration with abnormal blood vessel growth beneath the retina
- Sickle cell disease, which can affect retinal circulation
- High myopia, or severe nearsightedness, which places mechanical stress on the retina
- Retinopathy of prematurity in infants born early
Use of blood-thinning medications, bleeding disorders, hypertension, and previous eye surgery can also make existing bleeding more severe or increase the chance of future episodes.
Recognizing the Symptoms
The symptoms of vitreous hemorrhage vary based on how much blood has entered the eye. Some people notice only subtle visual changes, while others experience a dramatic and sudden loss of vision. Knowing what to watch for is essential for getting care at the right time.
The hallmark symptom of vitreous hemorrhage is sudden, painless vision loss in one eye. A small amount of bleeding may cause only a few new floaters or a mild haze. A large hemorrhage can reduce vision to the point where a person can only detect light or hand motion. The absence of pain does not mean the condition is minor.
Many people first notice new floaters that look like cobwebs, dark streaks, or tiny spots drifting across their visual field. Some describe a reddish or brownish tint to their vision. Vision may be noticeably worse in the morning, because blood settles over the central part of the retina during sleep. As the day progresses and the person stays upright, blood may shift downward and vision may partially improve.
Flashes of light, especially when they appear alongside new floaters, can indicate that the vitreous is pulling on the retina. A shadow or curtain closing in from one side of the visual field is a warning sign of retinal detachment, which is a serious, vision-threatening emergency. If you notice any of these symptoms, see a Retina Specialist or go to an emergency room right away.
- Sudden, painless loss of vision in one eye
- A large number of new floaters appearing all at once
- Flashes of light, especially with new floaters
- A shadow, curtain, or dark veil moving across your field of vision
- A red or brownish tint to your vision
How Vitreous Hemorrhage Is Diagnosed
Accurate diagnosis requires a thorough examination by a Retina Specialist and, in many cases, specialized imaging. Identifying both the hemorrhage and its underlying cause is essential for selecting the right treatment plan.
A Retina Specialist will begin with a dilated eye exam, using specialized lenses and a microscope to view the inside of the eye. In mild hemorrhages, parts of the retina may still be visible. In dense hemorrhages, blood can block the view entirely, making it impossible to assess the retina directly without additional testing.
When a hemorrhage is too dense to see through, a B-scan ultrasound is performed. This painless imaging test uses sound waves to create a detailed picture of the structures inside the eye. It can confirm whether the retina is still in its proper position, whether a tear is present, and whether any other abnormality, such as a tumor, is contributing to the bleeding. B-scan ultrasound is a critical diagnostic tool when a direct view of the retina is not possible.
For mild to moderate hemorrhages, advanced imaging provides additional detail to guide treatment decisions. Optical coherence tomography, or OCT, produces highly detailed cross-sectional images of the retina and allows our team to assess tissue health at a microscopic level. Wide-field fundus photography captures detailed images of the peripheral retina. Fluorescein and indocyanine green angiography use dye-based imaging to reveal blood vessel abnormalities and leakage. Our team performs serial retinal photo comparisons at every visit to track changes in disease status over time.
When the cause of the hemorrhage is not immediately clear, a Retina Specialist may recommend blood tests to check for diabetes, clotting disorders, or sickle cell disease. A thorough medical history helps identify contributing factors such as hypertension, blood-thinning medication use, or prior eye surgery. This information shapes both the treatment plan and the long-term monitoring approach.
Treatment Options
Treatment depends on the severity of the hemorrhage, the underlying cause, and whether the retina has been damaged. Our team will discuss the most appropriate approach based on your specific situation and imaging findings.
For mild hemorrhages without underlying retinal damage, a Retina Specialist may recommend watchful waiting. Small bleeds may resolve on their own over several weeks as the body absorbs the blood. During this time, regular follow-up exams are scheduled to track clearing and watch for retinal complications. Patients are typically advised to keep their head elevated, which encourages blood to settle away from the central visual axis.
For vitreous hemorrhage caused by proliferative diabetic retinopathy, intravitreal anti-VEGF injections can be an effective treatment. These medications block vascular endothelial growth factor, reducing the drive to grow abnormal blood vessels and helping to stabilize existing ones. Options in this medication class include Eylea (aflibercept), Lucentis (ranibizumab), Vabysmo (faricimab), and Avastin (bevacizumab).
Injections are given directly into the eye in a clinical setting and may be repeated every four to eight weeks depending on the response. Anti-VEGF therapy addresses the underlying cause of bleeding in diabetic cases and can reduce the risk of future episodes when used consistently.
Pars plana vitrectomy is a surgical procedure to remove the vitreous gel along with the blood it contains. A Retina Specialist performs this procedure using tiny instruments inserted through small openings in the white of the eye. Modern small-gauge vitrectomy systems have reduced surgical trauma and shortened recovery time considerably.
Vitrectomy is recommended when a hemorrhage does not clear on its own, when blood is too dense to allow safe examination of the retina, or when a retinal detachment is present. During surgery, the surgeon can also repair retinal tears, remove scar tissue, and apply laser treatment to the retina.
When a retinal tear or break is identified, retinal laser photocoagulation (a focused thermal laser that seals the retina around the tear) or cryopexy (a freezing treatment applied to the outer wall of the eye) is used to prevent progression to a full retinal detachment. In diabetic cases, panretinal photocoagulation, or PRP, may be applied across a wider area to reduce the stimulus for abnormal vessel growth. These treatments can be performed during vitrectomy or as standalone outpatient procedures.
Recovery and Long-Term Care
How quickly vision recovers depends on the treatment approach, the severity of the hemorrhage, and whether the underlying retinal condition has been addressed. Ongoing care after the initial treatment is just as important as the treatment itself.
With observation alone, a mild hemorrhage may clear over several weeks to a few months. After vitrectomy, many patients notice meaningful visual improvement within the first few weeks. If a gas bubble was placed inside the eye during surgery, specific head positioning instructions will be given and must be followed carefully. Activity restrictions, including avoiding heavy lifting and strenuous exercise, are typically in place for several weeks after surgery.
Persistent or untreated vitreous hemorrhage can lead to complications over time. Ghost cell glaucoma, a condition in which old red blood cells clog the eye's drainage system and raise internal eye pressure, can develop. Iron released from blood cells can damage retinal tissue over time. Scar tissue growth in the vitreous cavity can contract and pull on the retina. The most serious complication is retinal detachment, which requires urgent surgical repair and may result in lasting vision loss if not addressed promptly.
Preventing future episodes depends heavily on treating the condition that caused the hemorrhage in the first place. Patients with diabetes should work closely with their primary care provider or endocrinologist to maintain good blood sugar control, healthy blood pressure, and healthy cholesterol levels. Patients with retinal vein occlusion, sickle cell disease, or other contributing conditions should continue coordinated care with all of their medical providers. Regular dilated eye exams with a Retina Specialist remain essential for early detection of any new changes.
Frequently Asked Questions
These answers address common questions that go beyond what is covered in the sections above, including guidance on specific decisions and situations patients often face.
Yes, and recurrence is most likely when the underlying cause has not been fully addressed. Patients with proliferative diabetic retinopathy are at particularly high risk for repeated episodes if abnormal blood vessels continue to grow. Consistent treatment with anti-VEGF injections, laser therapy, or surgery can reduce that risk significantly. Your Retina Specialist will outline a monitoring plan designed to catch early signs of rebleeding before vision is severely affected.
Do not stop any prescribed medication without talking to both your Retina Specialist and your prescribing physician. Blood thinners are often given for serious conditions like heart disease or stroke prevention, and stopping them carries real medical risk. Your Retina Specialist and your primary care doctor or cardiologist should work together to find the right balance between protecting your eye and protecting your overall health.
In most cases, air travel is safe following a vitreous hemorrhage that has not required surgery. However, if a gas bubble was placed inside the eye during vitrectomy, flying is not allowed until the bubble has fully absorbed, because changes in cabin air pressure can cause dangerous increases in eye pressure. Always ask your Retina Specialist specifically about travel before booking any flights after eye surgery.
Visual recovery depends on more than just clearing the blood. The health of the retina before and during the hemorrhage plays a large role in the final outcome. If the retina was not permanently damaged by the bleeding or its underlying cause, vision has a good chance of returning to or near its previous level. However, conditions like advanced diabetic retinopathy or a prolonged, untreated detachment can cause lasting changes to retinal tissue that limit recovery. Early evaluation and treatment give the best chance of a favorable outcome.
Yes. A sudden increase in floaters, even without significant vision loss, can be an early sign of vitreous hemorrhage, a retinal tear, or the beginning of a retinal detachment. These conditions can progress quickly, and a retinal tear that goes untreated can develop into a full detachment within hours or days. A same-day or next-day evaluation by a Retina Specialist allows for proper imaging, an accurate diagnosis, and treatment before a serious complication develops.
See a Retina Specialist at Atlantic Retina Center
Vitreous hemorrhage requires expert evaluation and the right treatment at the right time. At Atlantic Retina Center, our fellowship-trained, ABO board-certified team specializes exclusively in the retina, vitreous, and macula, giving every patient the focused expertise this condition demands. We serve communities across the Eastern Shore of Maryland and central and southern Delaware from multiple clinic locations, so specialized retinal care is close to home. If you or someone you care for has experienced sudden vision changes, contact us to schedule an evaluation.