Vitreous Hemorrhage Treatment: New Updates

Vitreous or intraocular hemorrhage could occur as a result of many reasons, but it tends to occur more frequently among people with diabetes. This results from damage to the blood vessels in the back of the center of the eye. Thankfully, vitreous hemorrhage treatment is available to deal with the symptoms quickly to avoid vision loss.

Eye bleeding could develop among patients with type 1 or type 2 diabetes. The treatment of eye bleeding should be urgent without any further delay. Medications, injections, laser treatment, and eye surgery are all among the things that can help stop the bleeding.

Next, we will present the new updates regarding the treatment of vitreous hemorrhage, along with enough information to distinguish between vitreous hemorrhage and subconjunctival hemorrhage.

What Is Vitreous Hemorrhage?

Vitreous hemorrhage refers to the bleeding in the vitreous humor, a transparent watery layer located between the lens and retina in the middle of the eye. The condition is more common among people with diabetic retinopathy.

Other causes of vitreous hemorrhage include retinal tears or detachment, trauma, age-related macular degeneration, and eye surgery. Although the condition is often painless, it can lead to vision loss. People also report seeing dark spots and floaters as a result of bleeding in the eye.

Vitreous Hemorrhage Treatment

For mild cases of non-proliferative diabetic retinopathy, the treatment may not be necessary as bleeding inside the eye can disappear on its own. Its recommended to follow up with the doctor and undergo regular examinations. If the condition continues for more than 3 months or gets worse, your doctor may choose one of the following vitreous hemorrhage treatment options:

Anti-VEGF therapy

According to a study published in 2021, anti-VEGF therapy has been proven very effective and helpful in treating diabetic retinopathy, especially at earlier stages. Medications such as bevacizumab and ranibizumab are very famous anti-VEGF drugs that can deal well with vitreous hemorrhage cases. However, these drugs have their own set of side effects that provoke caution.

A new recent study published in 2022 also investigated the effect of anti-VEGF injections on the prevention of recurrent vitreous hemorrhage and indicated a positive effect for these injections. The study didn report systemic or ocular complications for these injections.

Laser Treatment

Old studies described laser treatment, also known as laser photocoagulation, as a "primary treatment" for vitreous hemorrhage. The doctor starts by examining the patient to determine the date of the laser surgery to seal the leaking vessels. The aim is to prevent blood from leaking from the capillaries and maintain vision.

Some research studies indicate that laser treatment can spare the patient the risk of vision loss. There are approximately 10% of cases of intraocular hemorrhage due to diabetes whose vision has improved more with laser treatment. Laser treatment can be repeated as the patients condition requires.

Steroid Injections

Intraocular or vitreous hemorrhage can occur with macular edema (a disease that occurs because of a tear in the blood vessels below the macula in the center of the retina). These cases do not improve with laser treatment, so doctors can inject the vitreous cavity with steroids to control blood leakage.

Invasive Surgery

Its possible to perform surgery to remove the vitreous humor of the eye. This option becomes more relevant in the case of retinal detachment. The surgery is called "vitrectomy", and it can repair retinal tears.

The surgeon inserts a small tool into the eye, then makes an incision and pulls the vitreous out. They may use a laser to separate the scar tissue or fibrous tissue from the retina. Some surgeons can also level the surface of the retina or treat the yellow spot or holes. After finishing the surgery, the surgeon injects the eye with a fluid to replace the vitreous and restore the eyes normal function.

Between 35-40% of diabetic people could suffer from intraocular pressure increases temporarily. If the situation continues without proper intervention, the patient becomes at great risk of developing clouding eye lenses, bleeding inside the eye, or eye contamination.

In the case of advanced (proliferative) diabetic retinopathy, there is an opportunity for new blood vessels to grow on top of the retina or into the vitreous cavity. In this case, treatment must include all areas of the retina because large areas around the retina are affected. The doctor can sacrifice peripheral vision in exchange for preserving the central vision related to the macula in some cases. The therapeutic goal is to eliminate the deformed blood vessels and prevent bleeding inside the eye.

Alternative Medicine

There are many studies that investigated alternative treatments for diabetic retinopathy and vitreous hemorrhage. This area still, however, requires more research. To ensure the feasibility of this type of treatment, and whether it is safe or not, it is important for the patient to inform the ophthalmologist regarding the use of any herbal or nutritional supplements.

Sometimes, these products may cause interactions with therapeutic drugs, leading to increased bleeding within the eye. It is better to choose proven drug treatments rather than alternative treatments that have not been proven effective for this condition.

Vitreous Hemorrhage or Subconjunctival Hemorrhage?

Many people confuse vitreous hemorrhage with subconjunctival hemorrhage. Both are referring to bleeding in the eye but in different locations. While vitreous hemorrhage occurs in the vitreous humor between the lens and retina, subconjunctival hemorrhage occurs in the clear membrane that lines the inside of the eyelid, also called the conjunctiva.

The conjunctiva is the transparent surface of the eye. If a blood vessel breaks under this surface, the result will be minor bleeding in most cases. Usually, people with this condition notice bright red pigmentation in their eyes, contrary to the normal white color.

In most cases, subconjunctival hemorrhage occurs without causing any complications to the patient. It also doesn require treatment and disappears within two weeks. Vitreous hemorrhage treatment, on the other hand, is more urgent and requires more attention.

Symptoms of Subconjunctival Hemorrhage

Red spots may appear on the white part of the eye. Indeed, this is the main symptom of the subconjunctival hemorrhage, but it doesn lead to vision or tear problems. It can, however, cause uncomfortable symptoms, such as itching.

Causes Subconjunctival Hemorrhage

There are a variety of causes that can lead to subconjunctival hemorrhage, including:

• Diabetes
• Strenuous activity
• Use of anticoagulants
• Severe cough
• Use of contact lenses
• Hypertension
• Increased vein pressure
• Getting a hit on the eye
• Frequent rubbing of the eye
• Severe sneezing

Diagnosis of Subconjunctival Hemorrhage

Doctors can diagnose subconjunctival hemorrhage by the following means:

• External eye examination
• Measuring the level of blood pressure
• Measuring the level of blood sugar
• Blood test

Treatment of Subconjunctival Hemorrhage

There are many types of eye drops that help absorb blood in the conjunctival area and reduce the feeling of itching or burning. In most cases, complications resolve within a short period of time. Despite being a very common condition in ophthalmology, the number of studies that investigated this condition is limited as was observed by an old study from 2013.

This might be due to the simplicity of the condition since it doesn pose a major threat to vision. Vitreous hemorrhage treatment takes a completely different path, especially if it is acute bleeding.

What to Consider When Treating Eye Bleeding?

Try to consider the following things when trying to deal with or treat eye bleeding:

• If the bleeding was the result of collisions or accidents, it becomes crucial to visit the doctor immediately to diagnose the condition and take proper medical measures.
• It is important for the patient to stop taking anticoagulants that increase the chances of subconjunctival hemorrhage. If the patient is taking these medications regularly to deal with medical issues- such as heart diseases and venous obstructions -it is important to consult a doctor before stopping these medications.
• If the bleeding becomes frequent, the ophthalmologist may choose various options to treat the condition, such as laser treatment.
• You should visit an eye doctor if an eye infection is the cause of the bleeding inside the eye. The doctor may prescribe antibiotics, whether in drops, pills, or ointments.

More About Diabetic Retinopathy

Since vitreous hemorrhage and subconjunctival hemorrhage are more common among people with diabetic retinopathy, its better to present some useful information about this condition as follows:

• Diabetic retinopathy is among the conditions that occur because of an imbalance in the blood sugar level. It can lead to vision problems. The incidence of this disease increases if the blood sugar remains out of control. Often the symptoms of diabetic retinopathy begin five years after a diabetes diagnosis.
• Sources indicate that 77% of people with diabetes type 1 suffer from symptoms of diabetic retinopathy. Controlling blood pressure reduces the incidence of diabetic retinopathy, which reduces the risk of vitreous hemorrhage.
• In the case you have diabetes, it becomes essential to visit an ophthalmologist every six months, even if there are no vision problems. Pregnant women should also have their eyes examined during pregnancy. If sudden vision change occurs, it is important to immediately visit an ophthalmologist.
• High blood sugar leads to a blockage in the small blood vessels that support the retina. The eye tries to replace these blood vessels with new ones, but the new blood vessels may not grow normally, which leads to bleeding inside the eye or vitreous hemorrhage.
• There are other factors that can cause retinopathy other than diabetes, including high blood pressure, high levels of bad cholesterol in the blood, smoking, and pregnancy. Also, there are some races that have a higher incidence of retinopathy, including people of Hispanic and African descent.

The Bottom Line

Vitreous hemorrhage treatment is achievable by different means, including anti-VEGF therapy and laser surgery. The new evidence points out to anti-VEGF therapy as being the most effective treatment method, but it comes with side effects.

Its very important to know the difference between vitreous hemorrhage and subconjunctival hemorrhage because they have different levels of urgency and treatment necessity.

International Clinics provides vitreous hemorrhage treatment and diagnosis for people with diabetic retinopathy. You can contact us directly by using the buttons on our website.

Read also: Uveitic Macular Edema: New Updates 2024