Vitreous haemorrhage

The vitreous fluid makes up around two-thirds of the eye's entire volume. Moreover, it is a transparent semi-solid or liquid fluid that fills the gap between the front lens and the retina that lines the back of the eye. Vitreous haemorrhage develops when a blood artery inside or near the vitreous cavity ruptures and bleeds. This condition can be caused due to several reasons such as diabetes, trauma, eye-related injury, etc.

Vitreous haemorrhage is caused by several factors. These factors include systemic disorders that promote abnormal growth of blood vessels due to a lack of oxygen and other eye conditions. This abnormal growth results in a vitreous haemorrhage. 

The following are some of the pathophysiological causes of vitreous haemorrhage:

1. Tears in the Retina
2. Detachment of the vitreous humour
3. Juvenile Retinoschisis (It affects the retina and is characterised by vision impairment)
4. Disciform degeneration (It is the abnormal growth of blood vessels under the retina)
5. Trauma
6. An intraocular tumour (eye cancer)
7. Uveitis (Inflammation of the middle layer of the eye or uvea)
8. Arteriosclerosis (Accumulation of fat or other substance in or on the artery walls)
9. Hypertension of the arteries
10. Blood dyscrasias (blood disorder)
11. Diabetic complications
12. Newly generated or atypical retinal vessels

Early Stage:

1. Floaters and blurred vision are the first signs of vitreous haemorrhage.
2. Patients report floaters as lines, spider webs, or numerous black specks, which we connect with bleeding.

Severe Stage:

1. There may be a visual impairment if the vitreous haemorrhage is severe.
2. When floaters or vision loss appear suddenly, a thorough retinal examination is essential to diagnose the root cause of the vitreous haemorrhage and evaluate whether any specified therapy is required.

Individuals who are at higher risk for vitreous haemorrhage are:

1. Patients who have diabetes
2. Older age groups 
3. Patients who are prescribed anticoagulant or antiplatelet drugs
4. Patients with systemic coagulation abnormalities and blood-related disorders

Recognizing symptoms, checking the eye, and doing tests to ascertain the reason are all used to diagnose vitreous haemorrhage. The following tests are some popular tests for vitreous haemorrhage:

1. Microscope inspection of the eye 
2. Assessing and dilapidating the pupils 
3. An ultrasound examination may be done if the doctor cannot view the rear of the eye well.
4. Blood testing to rule out particular causes, such as diabetes; 
5. A CT scan to rule out eye damage
6. Referral to a retinal expert.

Treatment will be chosen once the cause of the bleeding has been discovered. If there isn't too much blood in the vitreous and the cause of the bleeding can be identified, it's addressed. This includes:

1. Anti-VEGF injections: 
   1. These are intended to diminish aberrant new blood vessels in the eye. 
   2. To minimise bleeding in diabetic patients, they are occasionally used in conjunction with other treatments like laser photocoagulation and vitrectomy.
2. Cryotherapy: It is also useful in the treatment of retinal tears and detachments.
3. To Wait: 
   1. In the case of mild to moderate haemorrhage, the doctor advice to wait till the bleeding stops.
   2. As the vitreous clear progressively, it allows light to enter through it again.
   3. Normal eyesight will be recovered if the underlying vision is not impaired.

It is important to have an accurate and timely treatment for vitreous haemorrhage, as it may affect your visual acuity and could lead to conditions like:

1. Vitreous detachment
2. Ghost cell glaucoma
3. Optic nerve damage
4. Retinal detachment