A retinal hemorrhage is a blood in or to the retina which may present as a small and incidental find to a serious vision emergency. Also it may be related to diabetes, high blood pressure, retinal tears, or other retinal eye diseases which is why prompt diagnosis is of great importance.
This guide details the primary causes, signs, diagnosis and treatment of retinal hemorrhage also which procedures are considered a medical emergency.
What Is A Retinal Hemorrhage?
The retina is a light sensitive layer at the back of the eye which in turn is supplied by tiny blood vessels. A retinal hemorrhage which is a term we use when one or more of those blood vessels break and leak into the retina’s layers, in front of it, beneath it or into the vitreous body.
What we see is that the location of the bleed does play a role in terms of what the symptoms are, the degree of visual loss, and how we go about to treat it. What we call a vitreous hemorrhage is a bleed into the vitreous which may present as a sudden veil over vision or in some cases almost total loss of vision in that eye.
Types Of Retinal Bleeding
Different types of eye bleeding point to different causes. Eye doctors look at the size, shape, and location of the Hemorrhage to understand what is also going on systemically or inside the eye.
Also see:.
- Dot and patch Hemorrhage which present in diabetic retinopathy.
- Flame shaped Hemorrhage which are a feature of hypertension or vein occlusion.
- Preretinal Hemorrhage in which blood pools in front of the retina.
- Vitreous Hemorrhage which causes floaters or a haze in vision.
- Subretinal Hemorrhage which is associated with wet AMD or myopic degeneration.
Most Common Causes
Retinal Hemorrhage is a result of an underlying eye or systemic issue. In India diabetic retinopathy is the most prevalent cause, also we see that hypertension and retinal vein occlusion play large roles.
Also it includes:.
- Diabetes causes retinopathy which in turn leads to the growth of abnormal vessels that bleed easily.
- High blood pressure which may cause the breakage of very delicate retinal vessels.
- Retinal vein occlusive disease in which blood flow is compromised which in turn causes backup and leakage.
- Age related macular degeneration which includes the wet variety.
- Retinal tear or detachment.
- Valsalva retinopathy brought on by intense strain or coughing.
- Eye trauma.
- Blood disorders and use of anticoagulants.
Retinal Hemorrhage Symptoms
Symptom presentation is based on the degree and site of bleeding. What we see in some cases is almost no symptoms and they are brought to notice only at a detailed eye exam.
Look out for:
- Sudden floaters which may present as dark spots, webs, or threads.
- Blurry or foggy vision which is an issue when the macula is involved.
- Reddish, dark, or curtain like shadow in part of the field of vision.
- Sudden painless loss of vision which is a feature of vitreous Hemorrhage.
- May have no symptoms in small peripheral bleeds.
- Pain is not a usual feature unless there is another issue present like neovascular glaucoma or trauma.
Diagnosis At The Eye Hospital
In diagnosis we start with a dilated fundus exam which is the primary tool to identify the extent and pattern of bleeding. When the view is blocked by blood, doctors may use B scan ultrasound to look for retinal tears or detachment.
Also other tests may include:
- Optical coherence tomography for assessment of retinal layers.
- Fluorescein angiography to identify leaking vessels or neovascularisation.
- Blood tests including glucose, HbA1c, blood pressure check, full blood count, and coagulation studies as required.
These tests help determine the cause and guide treatment for broader retinal disease treatment as well.
Retinal Hemorrhage Treatment
Retina hemorrhage treatment is based on the cause of the issue and the degree of visual impairment. Some of the smaller Hemorrhages will resolve by themselves, but it is the root cause which requires attention.
Treatment options include:
- Observation of small bleeds in non critical areas as they may absorb over time.
- Laser photocoagulation to seal off leaking vessels or to treat retinal tears.
- Anti-VEGF injections of bevacizumab, ranibizumab, or aflibercept for wet AMD and proliferative diabetic retinopathy.
- Vitrectomy when blood doesn’t clear out or when retinal detachment is present.
- Systemic control of diabetes and blood pressure to prevent recurrence.
How Long It Lasts
Small intraretinal hemorrhages from hypertension or vein occlusion may absorb over 6–12 weeks. Larger vitreous Hemorrhage cases can take several weeks to months, and some do not clear without surgery.
Vision recovery depends on whether the macula was affected and on the underlying condition causing the bleed.
When To Seek Urgent Care
- See a doctor for your eyes right away if you notice:
- A sudden occurrence of floaters or flashes.
- Dark curtain over vision. Sudden painless loss of vision in one eye.
- A new red or black shadow which is growing.
These may be signs of retinal tear, detachment, or bleed in the eye which requires urgent care.
Vasan Eye Care
At Vasan Eye Care we perform a detailed retinal exam and use imaging to evaluate cases of retinal Hemorrhage which in turn helps us identify the cause right away. We have specialists that deal with retinal diseases and retinal eye disease which we approach with a combination of watchful monitoring, laser treatment, injection therapy and surgery when it is required.
Key Takeaways
- Retina bleed which is from damaged blood vessels in or around the retina we see in Retinal Hemorrhage.
- Diabetic retinopathy, hypertension, and retinal vein occlusion are common causes.
- Sudden floaters, haze, or a visual curtain should be checked the same day.
- Diagnosis typically includes dilated exam, OCT, and B scan ultrasound.
- Treatment may consist of watchful waiting, anti-VEGF injections, laser, or vitrectomy.
- Very tight control of blood sugar and blood pressure helps to prevent recurrence.
Frequently Asked Questions
Diabetic retinopathy is one of the most common causes, especially in India. High blood sugar weakens retinal blood vessels, leading to leakage and abnormal vessel growth.
Small Hemorrhages often absorb within 6–12 weeks, while vitreous Hemorrhages can take much longer. If the blood does not clear or if there is a tear or detachment, surgery may be needed.
The main signs are floaters, blurred vision, a shadow or curtain across vision, and sudden painless vision loss. Some small bleeds cause no symptoms and are found only on examination.
References
- StatPearls: Retinal Hemorrhage https://www.ncbi.nlm.nih.gov/books/NBK560777/
- Cleveland Clinic: Retinal Hemorrhage https://my.clevelandclinic.org/health/diseases/25106-retinal-hemorrhage
- Mayo Clinic: Retinal diseases https://www.mayoclinic.org/diseases-conditions/retinal-diseases/symptoms-causes/syc-20355825
- Medscape: Vitreous Hemorrhage Treatment https://emedicine.medscape.com/article/1230216-treatment
- EyeWiki: Vitreous Hemorrhage https://eyewiki.org/Vitreous_Hemorrhage