SECTION 29: VITREOUS HEMORRHAGE

Vitreous Hemorrhage
Summary
Spontaneous vitreous hemorrhage is a common disorder of
the vitreous cavity, occurring in approximately 7 per 100,000
people (Spraul & Grossniklaus 1997). The appearance of vitreous
hemorrhage develops secondary to bleeding from normal or
neovascular blood vessels within the retina/vitreous and also
may occur as a result of extension from layers underneath the
retina. The most common causes for nontraumatic, spontaneous
vitreous hemorrhage include diabetic retinopathy, retinal tear/
detachment, vitreoretinal traction resulting from posterior vitreous
detachment, retinal venous occlusive disease, ruptured retinal
macroaneurysm, and exudative age-related macular degeneration.
Spontaneous vitreous hemorrhage is a common cause for visual
impairment and often will resolve without treatment in mild cases.
More severe cases may require surgical vitrectomy. In the setting
of severe vitreous hemorrhage and no visualization of the fundus,
B-scan ultrasound is the imaging modality of choice. However,
Darin R. Goldman 29.1 
when vitreous hemorrhage is present with sufficient visualization
of the fundus, OCT can be helpful to identify underlying macular
abnormalities. Additionally, in cases of very subtle vitreous hemor-
rhage, OCT can be useful to confirm its presence.
Key OCT Features
• OCT findings in vitreous hemorrhage include visualization
of individual red blood cells, clumps of hemorrhage, and
secondary effects from shadowing (Figs. 1–4).
• Individual red blood cells appear as small, densely hyper-
reflective spots, whereas diffuse hemorrhage appears as a
homogeneous sheet of hyperreflectivity.
REFERENCE
Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol.
1997;42(1):3–39.

* * *
* *
*

Shadowing
artifact Vitreous
hemorrhage
S
3
N T

A B I

FIG. 1.  (A) Color photograph of diabetic vitreous hemorrhage. (B) OCT visualizes the posterior hyaloid face (arrowheads) with underlying hemorrhage
that is both attached to the back of the hyaloid (asterisks) and also dispersed within the underlying vitreous (between arrows). Where the hemorrhage
attached to the posterior hyaloid is thickest, the underlying details are obscured by shadowing artifact.

Vitreous hemorrhage
Sub-hyaloid
hemorrhage

S
1
N T

A B I

FIG. 2.  (A) Color photograph of diabetic vitreous hemorrhage, mostly contained in the sub-hyaloid space. (B) OCT shows mild vitreous hemorrhage
overlying the nasal macula. Temporally, there is subhyaloid hemorrhage (yellow arrow corresponds to same arrow in Fig. 2A) with underlying
shadowing artifact.

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 FIG. 3.  Vitreous hemorrhage secondary to 29.1 
ruptured retinal macroaneurysm. Where the
hemorrhage is denser, there is underlying
shadowing artifact (yellow arrows). Where the
hemorrhage is milder, there is no underlying
shadowing (white arrows).

Vitreous Hemorrhage
S
3
T N

S S
3 2
N T T N
Mild vitreous hemorrhage Vitreous hemorrhage
A I
B I

Red blood cells Vitreous Red blood

hemorrhage cells
streaks

S S
3 3
N T T N
Vitreous hemorrhage
C I
D I

Red blood Vitreous

cells hemorrhage streaks

FIG. 4A–E.  (A) Mild vitreous hemorrhage in the setting of acute posterior vitreous
detachment might go unnoticed clinically. Small, round, hyperreflective spots correspond
to individual red blood cells (arrows). (B) More significant vitreous hemorrhage with
shadowing artifact (between arrowheads) from overlying vitreous hemorrhage, which is
S
located above the imaged frame. Individual red blood cells are also visualized (arrows). (C)
5 In addition to red blood cells (arrows), the thickness map reveals a black segmentation
N T
artifact (circle) that is due to localized signal blockage from overlying vitreous hemorrhage
E I in this region. (D and E) Both red blood cells (white arrows) and hyperreflective, vertical
streaks of vitreous hemorrhage (yellow arrows) are shown.

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