Eye Hemorrhage

[gyaffe]

I had two rounds of laser surgery to correct retinal tears over the last couple of months. Things seemed to be going well until I developed a coating of small dots over my eye and some new, larger floaters. Vision from that eye is now heavily reduced.

The eye doctor said it was likely from a broken blood vessel caused by continuing PVD. I believe he said this was in the vitreous. His examination showed no new tears, He's put me on watch for now and told me to elevate my head at night with pillows to cause the spots in the eye to fall to the bottom of the eye.

His main concern seems to be new tears developing which led me to assume it was likely the dots and floaters would improve greatly if not go away completely on their own. However, after doing some reading, I'm not sure of this. I see that some people eventually need serious surgery, but I haven't been able to get an idea of how frequently the problem resolves itself on its own and how quickly. Do you have any statistics or estimates ?

[John C Hagan III, MD, FACS, FAAO]

Red tinge is usually blood.  Every retina surgeon has different criteria for when and who needs vitrectomy. Only he/her can answer your question.
JCH MD

[PZA]

Thank-you for helping people calm their nerves and better understand their condition.  I am a diabetic 25yrs  (40 y.o) and had a vitreous hemmhorage 5 weeks ago.  Sometimes it seems the blood is clearing, and other days it seems worse.  Today, I see a light red tinge, and worry the hemmhorage is bleeding again.  I used to have a "blob" of red blood at the bottom of my eye (which I could see coming down when I rest my head, as everything is reversed in the ete) and it is no longer there.  But my eye seems more blurry now.  So frustrating...Do you know what the red tinge might be?  I am really starting to think I need a vitrectomy...or am I jumping to fast??

[gyaffe]

I had been under the impression that PVD could go on indefinitely. Thank you for clearing that up and for all your other very valuable information and help. It is much appreciated.

Gene

[John C Hagan III, MD, FACS, FAAO]

Try using Google IMAGES   and type in posterior vitreous detachment.( PVD)  It has some good pictures that will help you.   PVD does not go on forever. Usually within several months the vitreous is completely retracted away from the retina and can no long pull on the retina and is not a threat to tear it. Usually the interface between the retina and the vitreous is easily separated. Sometime there are thin areas (example lattice degeneration) and it snags and creates the tear/bleed. Think about a zipper as long as it's on track there isn't a lot of traction on the cloth. If the zipper gets out of the groove and snags the coat it will pull on the fabric hard.

Remember that at age 50 half of us have PVDs perhaps fewer than 1% does it cause vitreous bleeding or retinal detachment. By age 70 the figure is 75% have PVDs.

JCH III MD

[gyaffe]

Thank you for being direct. I guess the good news is that I needn't yet despair of it clearing up on its own.

I was told this is likely due to continuing pvd. I'm having trouble picturing that. I can see pvd causing a pull on the retina and producing a tear in the retina. But I don't see how some small shrinking of the vitreous causes a blood vessel to break in the vitreous. Is this something you've run into ? If so, is it not that unusual in people with pvd and is it likely there'll be more broken blood vessels ?

Thanks again,

Gene

[John C Hagan III, MD, FACS, FAAO]

Well it can be a slow process. In diabetics that have an eye full of blood from proliferative retinopathy, ophthalmologists will often wait several months (say 2-6) for the blood to settle before doing a vitrectomy if it doesn't settle at all. The average red blood cell "lives" 120 days so it can take 3 months for the blood cells to die and start to decompose in the vitreous.

JCH III MD

[gyaffe]

As far as I know the only problem I have is PVD. I'm not diabetic, no new retinal tears have been found, and no cataract surgery has been done--though I'm told I have a cataract that's not yet affected my vision.

However, it's been 4 days and I've noticed no improvement. The spots and swirls in my eye have not diminished much, if at all. I'm getting very concerned. Can you give me an idea how long it should take for the blood to reabsorb --days, weeks or months ?

Thanks,

Gene

[John C Hagan III, MD, FACS, FAAO]

Blood in the vitreous is not like floaters in the vitreous. The blood will generally settle to the bottom and the red and white blood cells die, disolve and are rinsed out of the eye. In a small number of cases (usually diabetics with proliferative retinopathy) the bleeding continues or doesn't settle then the blood is removed in an operation called a vitrectomy.

If the only problem you have is a posterior vitreous detachment (PVD), its quite likely the blood will reabsorb and surgery will not be necessary.  The odds are heavily in your favor: by age 50 half of the populations has PVDs and by age 70 its 75% but a retinal detachment occurs in about 1 in 3,000 to 5,000 people that have not had cataract surgery.

JCH III MD