Introduction
What Is Vitreous Haemorrhage?
Vitreous haemorrhage is a vision-threatening condition that occurs when blood leaks into the vitreous humour — the clear, gel-like substance that fills the inside of the eye. Even a small amount of blood can cloud vision, while more severe bleeding can lead to significant visual loss or even blindness.
The condition can develop suddenly and without pain, often causing floaters, shadows, or blurred vision. Vitreous haemorrhage isn’t a disease itself, but rather a symptom of an underlying issue such as diabetic eye disease, retinal tears, trauma, or vascular abnormalities. Early diagnosis is essential, as treatment depends on identifying and managing the root cause. In some cases, the blood clears on its own, while others may require surgery to restore vision.
Causes and Risk Factors of Vitreous Haemorrhage
What Causes Vitreous Haemorrhage?
Vitreous haemorrhage occurs when blood leaks into the vitreous — the clear, gel-like substance that fills the centre of the eye — disrupting vision. This bleeding can result from damage to retinal blood vessels or the growth of fragile, abnormal vessels often associated with underlying eye conditions. Depending on the cause and severity, the haemorrhage may resolve on its own or require surgical intervention.
Key risk factors include:
- Diabetic Retinopathy – A leading cause due to abnormal blood vessel growth that easily ruptures
- Retinal Tears or Detachment – Damage to retinal vessels during tearing can lead to bleeding into the vitreous
- Eye Trauma – Blunt or penetrating injuries can rupture blood vessels and cause immediate haemorrhage
- Retinal Vein Occlusion – Blocked veins in the retina may leak blood into the vitreous cavity
- Age-Related Conditions – Degenerative changes can weaken blood vessels over time
- Sickle Cell Retinopathy – Blood vessel abnormalities related to sickle cell disease can result in bleeding
- Ocular Tumours – Rarely, tumours can cause internal eye bleeding through vessel disruption
- High Myopia – Severe short-sightedness stretches and thins the retina, increasing the chance of vessel rupture
Recognising and managing these underlying conditions is essential in preventing recurrent haemorrhages and preserving vision.
Types of Vitreous Haemorrhage
The Different Types of Vitreous Haemorrhage
Understanding the Forms and Causes of Vitreous Bleeding
Vitreous haemorrhage can present in varying degrees of severity and arise from different underlying causes. While it isn’t officially classified into “types,” clinicians often distinguish haemorrhages based on their cause and extent, which helps guide treatment.
Mild Vitreous Haemorrhage
Description:
Small amounts of bleeding causing floaters or hazy vision. Often clears on its own without surgery.Who it affects:
Common in early-stage diabetic eye disease or minor trauma cases.Speed of progression:
Slow and sometimes resolves spontaneously over weeks to months.
Moderate to Severe Vitreous Haemorrhage
Description:
Denser bleeding that significantly obscures vision and may settle overnight, making morning vision worse.Who it affects:
Patients with proliferative diabetic retinopathy, retinal vein occlusion, or trauma.Speed of progression:
Can worsen suddenly. May need surgical removal (vitrectomy) if vision doesn’t improve.
Tractional or Recurrent Haemorrhage
Description:
Bleeding caused by traction from scar tissue or neovascular vessels pulling on the retina, often recurring.Who it affects:
Those with advanced diabetic eye disease or previous retinal detachment.Speed of progression:
Varies. Can lead to permanent damage if not managed with timely surgery.
Early Signs & Symptoms
Common Symptoms of Vitreous Haemorrhage
Vitreous haemorrhage often presents suddenly and without pain. Depending on the severity, vision changes can range from mildly irritating to severely impairing. Prompt assessment is essential, especially if you are at risk of retinal detachment or diabetic eye disease.
Sudden appearance of floaters
You may notice small spots, cobwebs, or strands drifting in your vision — often one of the first signs.
Blurry or clouded vision
Vision can become hazy or “foggy,” particularly if the bleeding obscures light reaching the retina.
Dark streaks or shadows
Larger haemorrhages may create dark lines or shadows that drift or shift with eye movement.
Photophobia (light sensitivity)
Bright lights may feel uncomfortable or cause glare, especially in rooms with high contrast.
Worse vision in the morning
Blood in the eye may settle overnight, making vision more impaired upon waking.
Sudden, painless vision loss
In severe cases, vision may drop dramatically — a red flag that needs urgent medical attention.
Diagnosis and Treatment of Vitreous haemorrhage
Vitreous haemorrhage is diagnosed through a comprehensive eye examination. Your ophthalmologist will dilate your pupils using special drops to examine the retina and assess the severity and possible cause of the bleeding. If the view of the retina is obscured due to blood in the eye, ocular ultrasound may be performed to detect underlying issues such as retinal detachment or tears.
In many mild cases, no immediate treatment is needed — the blood often clears on its own over several weeks. However, persistent or severe haemorrhages may require a procedure called vitrectomy to remove the blood and treat any underlying retinal problems.
Advances in sutureless vitrectomy techniques now allow for quicker recovery and fewer complications. The decision to operate depends on the severity of bleeding, cause, and risk to vision.
Why Timely Diagnosis Matters
Don’t Ignore Sudden Changes in Vision
Vitreous haemorrhage can be alarming, but in some cases, it may resolve without intervention. However, it’s crucial to determine the underlying cause, as it could indicate serious conditions like diabetic retinopathy or retinal detachment — both of which require urgent care to prevent permanent vision loss.
Prompt diagnosis ensures your ophthalmologist can:
- Identify whether the bleeding is mild or severe
- Detect sight-threatening issues such as retinal tears or detachment
- Monitor or treat underlying diseases like diabetes-related eye changes
- Minimise risk of complications through timely intervention
- Preserve vision through early treatment such as vitrectomy
If you experience sudden floaters, blurred vision, or visual shadows — seek medical attention immediately.
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Quick Answers About Vitreous Haemorrhage
Will my vision return to normal?
In mild cases, vision may gradually improve as the blood is reabsorbed. Severe cases may need surgery to restore or stabilise vision.
How long does it take to recover?
Small haemorrhages can resolve in weeks, but more significant ones may take months — or require vitrectomy surgery if blood persists.
Should I see a specialist urgently?
Yes. Sudden floaters, flashes, or vision loss could signal something more serious like a retinal detachment. Prompt assessment is vital.
