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Vitreous Hemorrhage: Causes, Symptoms, and Treatment
Who Is at Risk
Vitreous hemorrhage can occur at any age, though the most common causes differ between younger and older adults. It is one of the most frequent causes of sudden, painless vision loss and affects a meaningful number of people each year.
Proliferative diabetic retinopathy is the leading cause of vitreous hemorrhage in adults, accounting for a large portion of all cases. Chronic high blood sugar damages the blood vessels that supply the retina, and the eye responds by growing new, fragile vessels that break and bleed easily. Poor blood sugar control significantly raises this risk over time.
As people age, the vitreous gel naturally shrinks and pulls away from the retina in a process called posterior vitreous detachment (PVD). PVD becomes increasingly common after age 60. When the vitreous separates, it can tug on retinal blood vessels and cause them to rupture. PVD-related hemorrhage carries a significant risk of a concurrent retinal tear, which requires prompt evaluation.
Eye trauma is the leading cause of vitreous hemorrhage in people under 40, with males at higher risk in this group. A direct blow to the eye or head can rupture blood vessels inside the eye even when no obvious external injury is visible. Any trauma followed by sudden vision changes should be evaluated the same day by a Retina Specialist.
Several other conditions can lead to vitreous hemorrhage.
- Retinal vein occlusion, which is a blockage in the veins that drain the retina
- Sickle cell disease, particularly in patients of African descent
- Age-related macular degeneration with abnormal new vessel growth
- High myopia, which is severe nearsightedness
- Retinopathy of prematurity in premature infants
Use of blood-thinning medications or the presence of a bleeding disorder can also make an existing hemorrhage more severe. High blood pressure and hardening of the arteries weaken vessel walls over time and may contribute to bleeding as well.
Signs and Symptoms
The symptoms of vitreous hemorrhage depend on how much blood has entered the eye and where it settles. Recognizing the warning signs early and responding quickly can protect your vision.
The hallmark symptom is sudden, painless vision loss in one eye. A small bleed may cause only a few new floaters or a light haze, while a large hemorrhage can reduce vision to the point where a person can only detect light or hand movement. Because the bleeding is painless, it is sometimes mistaken for something minor, which can delay care.
Many people first notice new floaters that appear as cobwebs, dark streaks, or tiny spots drifting across their visual field. Some describe a reddish or brownish tint to their vision caused by the blood itself. Vision may also be noticeably worse in the morning, because blood settles over the macula (the central part of the retina) during sleep, then partially shifts when a person sits upright during the day.
Some symptoms signal a retinal tear or detachment that needs emergency evaluation.
- A sudden flood of new floaters, especially dark streaks or cobweb-like shapes
- Flashes of light, particularly when combined with new floaters
- A shadow or curtain closing in from the edge of your visual field
- A sudden significant drop in vision or loss of vision in one eye
- A red or brownish tint spreading across your field of view
If you notice any of these symptoms, contact a Retina Specialist immediately or go to the emergency room the same day. A shadow or curtain closing in from the side of vision is a warning sign of retinal detachment, which is a vision-threatening emergency.
Diagnosis and Testing
Accurate diagnosis requires a thorough examination and, in many cases, specialized imaging. A Retina Specialist will choose the right combination of tools based on the density of the hemorrhage and your medical history.
The evaluation begins with a dilated eye exam, in which eye drops are used to widen the pupil so that the inside of the eye can be examined in detail. Using a specialized microscope and lens, the Retina Specialist can assess the extent of bleeding and look at the retina when the hemorrhage is mild enough to see through. In dense hemorrhages, the blood blocks the view entirely, requiring additional imaging.
When blood is too thick to see through, a B-scan ultrasound is performed. This painless test uses sound waves to create a detailed image of the structures inside the eye without relying on light passing through the blood. It can show whether the retina is still attached, whether a retinal tear is present, and whether there are signs of a tumor or other abnormality. B-scan ultrasound is an essential tool when direct retinal examination is not possible.
In cases where some visibility remains, our team uses a full retinal imaging suite to gather additional detail. Optical coherence tomography (OCT) produces high-resolution cross-sectional images of the retina. Fluorescein and ICG angiography use a safe dye to highlight blood vessel activity and identify areas of abnormal growth or leakage. Color fundus photography and widefield imaging capture the full extent of retinal involvement, helping our Retina Specialists plan the most effective course of treatment.
When the cause is not immediately clear, blood tests can check for diabetes, clotting disorders, or sickle cell disease. A detailed medical history helps identify risk factors such as high blood pressure, use of blood-thinning medications, or prior eye surgery. This information guides both the diagnosis and the overall treatment plan.
Treatment Options
Treatment depends on the cause and severity of the hemorrhage, whether the retina is intact, and how quickly the blood is clearing. Our Retina Specialists individualize every treatment plan based on your specific situation.
For mild hemorrhages without signs of underlying retinal damage, a Retina Specialist may recommend careful observation. Small bleeds often resolve on their own over several weeks as the body absorbs the blood naturally. Regular follow-up exams are scheduled to monitor how well the blood is clearing and to check for any developing retinal complications. Patients are usually advised to sleep with their head elevated to help blood settle away from the center of vision.
For vitreous hemorrhage caused by proliferative diabetic retinopathy or abnormal blood vessel growth, intravitreal anti-VEGF injections are an effective treatment option. These medications are injected directly into the eye and work by blocking the VEGF protein that drives abnormal vessel growth and leakage. Options used in clinical practice include aflibercept (Eylea), ranibizumab (Lucentis), and bevacizumab (Avastin, which is FDA-approved for cancer and used off-label for eye conditions). Injections may be repeated every four to eight weeks depending on how your eye responds.
Pars plana vitrectomy is a surgical procedure that removes the vitreous gel and the blood within it from inside the eye. Our Retina Specialists perform this procedure using very small instruments inserted through tiny openings in the white of the eye. Modern small-gauge vitrectomy systems have reduced surgical trauma and improved recovery times compared to older techniques.
Vitrectomy is recommended when the hemorrhage does not clear on its own, when the blood is too dense to allow safe examination of the retina, or when a retinal detachment is present. During the same procedure, the specialist can repair retinal tears, remove scar tissue, and apply laser treatment directly to the retina.
When a retinal tear or break is found, laser photocoagulation (a thermal laser that seals the retina around the tear) or cryopexy (a controlled freezing treatment) is used to prevent the tear from becoming a full retinal detachment. In diabetic eye disease, panretinal photocoagulation may be applied across a wider area of the retina to reduce the stimulus for abnormal blood vessel growth. These treatments can be performed during vitrectomy or as standalone procedures depending on the clinical situation.
Recovery and Ongoing Care
How quickly vision recovers depends on the severity of the hemorrhage, the underlying cause, and the treatment performed. Understanding what to expect helps patients stay on track with follow-up care and protect their long-term vision.
With observation alone, a mild hemorrhage may take several weeks to a few months to fully clear. After vitrectomy, many patients notice meaningful improvement in vision within the first few weeks. Final visual outcomes depend significantly on whether the retina itself was damaged, either by the hemorrhage or by the condition that caused it. Our Retina Specialists will give you a realistic expectation based on your individual case.
If a gas bubble was placed inside the eye during surgery to help flatten the retina, specific head positioning will be required for several days afterward. Activity restrictions, including avoiding heavy lifting and strenuous exercise, are typically in place for a few weeks following surgery. For patients being managed with observation or anti-VEGF injections, regular monitoring appointments are essential to confirm that the blood is clearing and that no new complications are developing.
Untreated or persistent vitreous hemorrhage can lead to serious secondary problems. Ghost cell glaucoma can develop when old, degenerated red blood cells clog the eye's drainage system and raise eye pressure. Iron released from deteriorating blood cells can become toxic to retinal tissue over time. Recurrent hemorrhage is possible when the underlying cause remains active. The most dangerous complication is retinal detachment, which requires urgent surgical repair and can result in lasting vision loss if not treated promptly.
Long-term prevention depends on controlling the conditions that caused the hemorrhage in the first place. For patients with diabetes, maintaining good blood sugar, blood pressure, and cholesterol control is one of the most effective ways to reduce the risk of future bleeding. Patients with sickle cell disease, retinal vein occlusion, or other contributing conditions should stay in close coordination with both their primary care team and their Retina Specialist to protect their vision over time.
Frequently Asked Questions
These answers address common questions patients have when navigating a vitreous hemorrhage diagnosis, including decisions about activity, medications, and what to expect beyond initial treatment.
Yes, recurrence is possible, particularly when the underlying cause has not been fully controlled. Patients with proliferative diabetic retinopathy are at the highest risk for repeat bleeding if abnormal vessels continue to grow. Anti-VEGF therapy, laser treatment, or surgery can significantly reduce this risk, but ongoing monitoring remains important. Your Retina Specialist will recommend a follow-up schedule based on how stable your condition is after initial treatment.
The blood itself does not usually cause permanent retinal damage if it is cleared within a reasonable time frame. The greater concern is the underlying condition that caused the bleeding, such as a retinal tear, retinal detachment, or advanced diabetic retinopathy, all of which can harm the retina directly. Prolonged hemorrhage can also lead to iron toxicity within the eye over time, which is one reason prompt evaluation and treatment planning matters even when vision loss seems mild.
This depends on the severity of the hemorrhage and whether surgery has been performed. Strenuous exercise and heavy lifting are generally discouraged during active bleeding and in the early weeks following vitrectomy. Air travel requires special caution if a gas bubble was placed inside the eye during surgery, because changes in cabin pressure can expand the gas and raise eye pressure dangerously. Always ask your Retina Specialist for personalized activity guidance before resuming physical activity or travel.
Do not stop any medication without first speaking with both your Retina Specialist and the doctor who prescribed the blood thinner. These medications are often prescribed for serious conditions like heart disease, atrial fibrillation, or stroke prevention, and stopping them suddenly can create its own medical risks. Your eye care and medical teams will work together to weigh the risks and benefits and decide on the safest approach for your overall health.
New floaters can be caused by several conditions, including normal age-related vitreous changes (PVD), retinal tears, vitreous hemorrhage, or inflammation inside the eye. There is no reliable way to distinguish these causes on your own, which is why any sudden increase in floaters, especially when accompanied by flashes of light or a shadow in your vision, should be evaluated promptly by a Retina Specialist. A dilated eye exam, and in some cases ultrasound imaging, is the only way to determine the cause and rule out something serious.
If the hemorrhage clears on its own and no underlying retinal damage is present, outcomes can still be good without active treatment in some mild cases. However, leaving a significant hemorrhage unmonitored is risky because it can mask a retinal tear or detachment that progresses undetected. Over time, untreated hemorrhage can also lead to elevated eye pressure or retinal toxicity. Waiting to see a specialist increases the chance that a treatable condition becomes a more complicated one.
Expert Retina Care in Northern Virginia
Our visiting Retina Specialists at The Eye Center bring advanced surgical expertise and the full retinal imaging suite needed to diagnose and treat vitreous hemorrhage accurately and efficiently. We understand how frightening a sudden change in vision can be, and our team is committed to giving you clear answers and a personalized care plan from your very first visit. If you are experiencing symptoms of vitreous hemorrhage or have been told you need retinal evaluation, we encourage you to contact us to schedule an appointment at our retina clinic in Lansdowne or at one of our other convenient locations.