Disease Description (Causes and Symptoms)
- Definition summary: Retinal hemorrhage is a condition in which blood vessels within the retina rupture and blood collects in the retinal layers or vitreous cavity; symptoms and prognosis vary depending on the cause and the area involved.
- Major causes: Diabetic retinopathy (especially proliferative), hypertensive retinopathy, age-related macular degeneration, retinal vascular occlusion, trauma, blood disorders (leukemia and coagulation disorders), inflammatory diseases (retinitis), preeclampsia, etc.
- Pathophysiology summary: Retinal vascular microaneurysms, neovascularization, or damage to the vessel walls causes vessel rupture → bleeding within the retinal layers, subretinal bleeding, or vitreous hemorrhage → photoreceptor damage, visual field obstruction, neovascularization, and tractional adhesions.
- Major symptoms: Sudden floaters, a dark cloud or curtain-like obstruction in front of the eye (visual field defect), and partial or overall decreased vision. The onset and severity of symptoms vary depending on the amount and location of bleeding (including whether the macula is involved).
- Diagnostic tests: Fundus examination through dilated pupils (direct and indirect), fundus photography to identify pigment and the location of hemorrhage, OCT (evaluation of macular edema and blood accumulation), fluorescein fundus angiography (identification of nonperfusion and neovascularization), and B-scan ultrasonography when observation is not possible because of vitreous opacity. Blood pressure measurement and testing of blood glucose, HbA1c, and blood tests (for blood disorders and coagulation) are recommended to differentiate systemic causes.
Treatment Methods
- Principle: Treatment of the underlying disease combined with local treatment to minimize vision loss.
- Conservative treatment
- Small intraretinal hemorrhages may be naturally absorbed and resolve with observation and ophthalmologic follow-up.
- Management of systemic diseases: Strict control of blood glucose, blood pressure, and lipids, along with evaluation and adjustment of anticoagulant use.
- Medication treatment
- When vitreous or retinal neovascularization or macular edema is the cause, intravitreal anti-VEGF injections (e.g., bevacizumab) can suppress neovascularization and reduce macular edema.
- Steroid intravitreal injections may be used selectively (for macular edema, etc.) (side effects: increased intraocular pressure and cataracts).
- Laser treatment
- In proliferative diabetic retinopathy, panretinal photocoagulation (PRP) is used to suppress the progression of neovascularization.
- Selective laser treatment may be applied depending on the focal retinal lesion.
- Surgical treatment
- When a large amount of vitreous hemorrhage does not resolve or visual recovery is not possible, vitrectomy is performed to remove blood and adhesions.
- When tractional retinal detachment is present, vitreoretinal surgery and retinal reattachment surgery are required.
- Follow-up and lifestyle management
- Continued management of the underlying disease (especially diabetes and hypertension), smoking cessation, and regular ophthalmologic examinations (patients with diabetic retinopathy should follow the recommended schedule).
- Visit an ophthalmologist immediately when acute symptoms occur (such as severe vision loss or a curtain-like obstruction).
- Precautions (risk of complications and self-management)
- Permanent vision loss may occur due to macular involvement, recurrent hemorrhage, persistent vitreous hemorrhage, tractional retinal detachment, or neovascular glaucoma.
- Because anti-VEGF and steroid injections carry risks such as infection (endophthalmitis) and increased intraocular pressure, immediate medical attention is needed if abnormal symptoms (pain, sudden vision loss, or redness) occur.
- People taking anticoagulants should consult their treating physician, taking the risk of bleeding into consideration.
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Recommended items to bring
- A list of recently used medications and supplements (especially anticoagulants, antiplatelet drugs, and anticancer drugs)
- HbA1c and recent blood glucose and blood pressure records (test results, if available)
- Previous ophthalmologic examination results (copies of fundus photographs, OCT, and fluorescein fundus angiography) and surgical history
- The time symptoms began, how they have changed (suddenly/gradually), whether both eyes are affected, and whether driving is possible
- A history of trauma, pregnancy status, and a history of systemic diseases (diabetes, hypertension, blood disorders, cancer, etc.)
- Information about examinations that may be performed during the outpatient visit
- Dilated fundus examination, OCT, and, if necessary, fundus photography, fluorescein fundus angiography, B-scan ultrasonography, blood tests, etc.
- Sample questions (helpful for preparing answers during the consultation)
- When did the symptoms first begin? Which eye is affected, and did they occur all at once?
- Have you recently experienced trauma or undergone eye surgery?
- Have you ever been diagnosed with diabetes, hypertension, or a blood disorder (such as leukemia)?
Examples of General Questions to Ask the Doctor
- What appears to be the cause of this hemorrhage? Are additional systemic tests needed?
- What treatment do you recommend for my condition (laser treatment, anti-VEGF, or surgery), and what are its advantages, disadvantages, and side effects?
- How much visual recovery can be expected after treatment? What lifestyle changes should I make to reduce the risk of recurrence?
Examples of Condition-Specific Questions
- If diabetes is the cause: "If the hemorrhage is due to diabetic retinopathy, which combination of laser treatment and anti-VEGF do you recommend? What HbA1c level should I maintain?"
- If massive vitreous hemorrhage is suspected: "Is the current hemorrhage likely to be absorbed naturally, or should vitrectomy be considered? What are the expected recovery period and complications of surgery?"