Dr. Griffiths and her staff at NewView are professional, warm, and attentive. Her expert laser surgery restored my vision, put me at ease, and I trust her fully for eye care and facial procedures.
Dee Greenwich
Vitreous Hemorrhage: Causes, Treatment, and Recovery
Who Is at Risk
Vitreous hemorrhage can affect people of all ages, though the most common causes differ between younger and older adults. Several medical conditions and physical factors increase a person's risk.
Proliferative diabetic retinopathy (advanced diabetic eye disease in which abnormal blood vessels grow on the retina) is the leading cause of vitreous hemorrhage in adults. Chronic high blood sugar damages retinal blood vessels over time, prompting the eye to grow new, unstable vessels that are prone to bleeding. Poor blood sugar control significantly increases this risk.
As people age, the vitreous gel naturally shrinks and pulls away from the retina. This process is called posterior vitreous detachment, or PVD, and it becomes more common after age 60. When the vitreous separates, it can tug on retinal blood vessels and cause them to bleed.
PVD-related vitreous hemorrhage also carries a meaningful risk of a concurrent retinal tear or break, which makes prompt evaluation especially important.
Eye trauma is the leading cause of vitreous hemorrhage in people under 40, and males are at higher risk in this category. Other conditions that can cause vitreous hemorrhage include:
- Retinal vein occlusion (a blockage in the veins that drain the retina)
- Sickle cell disease, particularly in Black populations
- Age-related macular degeneration with abnormal blood vessel growth
- High myopia (severe nearsightedness)
- Retinopathy of prematurity in infants
Several additional factors can increase the risk of vitreous hemorrhage or make bleeding more severe. Previous cataract surgery can change the structure of the vitreous and increase the likelihood of PVD. Blood-thinning medications or bleeding disorders may prolong existing hemorrhage. Hypertension and atherosclerosis can weaken blood vessel walls over time, making rupture more likely.
Signs and Symptoms
Vitreous hemorrhage often announces itself suddenly and without pain. Recognizing the warning signs early can make a significant difference in outcomes.
The most characteristic sign of vitreous hemorrhage is sudden, painless vision loss in one eye. How much vision is affected depends on the amount of blood that enters the vitreous. A small bleed may cause only a few new floaters or mild haze, while a large hemorrhage can reduce vision to the point where a person sees only light or motion.
Many people first notice new floaters that look like cobwebs, dark streaks, or tiny spots drifting through their field of vision. Some describe a reddish or brownish tint to their vision. Vision may be worse in the morning because blood settles over the macula (the central part of the retina responsible for detailed vision) during sleep. As the day goes on and the person remains upright, blood may shift and vision may partially improve.
Certain symptoms suggest a more serious underlying problem, such as a retinal tear or retinal detachment (when the retina lifts away from the back of the eye). These require same-day or emergency evaluation.
- A shadow or curtain closing in from the side of your visual field
- Flashes of light, especially when accompanied by new floaters
- A sudden dramatic increase in floaters or dark spots
- A significant and rapid drop in overall vision
If you experience any of these symptoms, contact a Retina Specialist right away or seek emergency care. Delays can allow a treatable retinal tear to progress into a retinal detachment, which is far more difficult to repair.
How Vitreous Hemorrhage Is Diagnosed
Accurate diagnosis is essential because vitreous hemorrhage can have several different underlying causes, some of which require urgent treatment. A thorough evaluation helps guide the most appropriate course of action.
A Retina Specialist will begin with a dilated eye exam, using special lenses and a microscope to look for blood in the vitreous and assess the retina. In mild hemorrhages, the retina may still be visible. In dense hemorrhages, the blood can block the view of the retina entirely, making additional testing necessary.
When a hemorrhage is too dense to see through, a B-scan ultrasound is performed. This painless test uses sound waves to create an image of the internal structures of the eye. It can reveal whether the retina is still properly attached, whether a retinal tear is present, and whether there are any signs of a tumor or other abnormality.
In cases of mild to moderate hemorrhage, advanced imaging can provide important additional detail. Optical coherence tomography, or OCT, produces high-resolution cross-sectional images of the retina. Widefield imaging systems can capture detailed photographs of the retina's outer edges. Together, these tools help identify the root cause and guide treatment planning.
If the cause of the hemorrhage is not immediately clear, a Retina Specialist may recommend blood tests to check for diabetes, blood clotting disorders, or sickle cell disease. A thorough review of your medical history, including any history of hypertension, blood-thinning medications, or prior eye surgery, helps complete the picture.
Treatment Options
Treatment for vitreous hemorrhage depends on the cause, the severity of the bleeding, and whether the retina has been affected. A Retina Specialist will recommend the approach most appropriate for your specific situation.
For mild hemorrhages without underlying retinal damage, a Retina Specialist may recommend watchful waiting. Small bleeds sometimes resolve on their own over several weeks as the body gradually absorbs the blood. During this time, patients are typically advised to keep their head elevated, which helps blood settle away from the center of the visual field.
Regular follow-up exams are essential during this period to confirm that the blood is clearing and to watch for any developing retinal complications.
For vitreous hemorrhage caused by proliferative diabetic retinopathy, intravitreal anti-VEGF injections can be effective. These medications, injected directly into the eye, block the VEGF protein that drives abnormal blood vessel growth. Common options include aflibercept, ranibizumab, and bevacizumab, the last of which is used off-label for eye conditions. Injections may be repeated every four to eight weeks depending on the response.
Pars plana vitrectomy is a surgical procedure in which a Retina Specialist removes the vitreous gel and the blood contained within it using tiny instruments inserted through small openings in the white of the eye. Modern small-gauge vitrectomy systems have reduced surgical trauma and shortened recovery time significantly.
Vitrectomy is typically recommended when the hemorrhage does not clear on its own, when the blood is too dense to allow examination of the retina, or when a retinal detachment is present. During surgery, the specialist can also repair retinal tears, remove scar tissue, and apply laser treatment as needed.
When a retinal tear or break is identified, laser photocoagulation (a thermal laser that seals the retina) or cryopexy (a freezing treatment applied to the outer surface of the eye) is used to prevent progression to retinal detachment. In diabetic cases, a broader laser treatment called panretinal photocoagulation may be used to reduce abnormal blood vessel growth. These treatments can be performed during vitrectomy or as standalone procedures.
Recovery and What to Expect
Recovery from vitreous hemorrhage varies depending on the cause, the severity of the bleeding, and the treatment approach used. Most patients can expect a gradual improvement in vision, though the timeline differs from person to person.
With observation alone, a mild hemorrhage may clear over several weeks to a few months. After vitrectomy, many patients notice meaningful improvement within the first few weeks. Final visual outcomes depend on whether the underlying retina was damaged by the hemorrhage or its root cause, since blood alone does not usually cause permanent vision loss.
After vitrectomy, a Retina Specialist may instruct you to maintain a specific head position for several days, particularly if a gas bubble was placed inside the eye to help hold the retina in place. Activity restrictions, including avoiding heavy lifting and strenuous exercise, are typically in place for a few weeks following surgery.
Patients being managed with observation or anti-VEGF injections should keep all monitoring appointments, since regular check-ins are essential to confirm that the blood is clearing and to catch any complications early.
Persistent vitreous hemorrhage that goes untreated can lead to serious complications over time. Ghost cell glaucoma (elevated eye pressure caused by old blood cells clogging the eye's drainage system) can develop. Iron released from blood cells can become toxic to retinal tissue with prolonged exposure. Recurrent bleeding is possible if the underlying cause is not addressed.
The most serious complication is retinal detachment, which requires urgent surgical repair and can lead to lasting vision loss if not treated promptly.
Managing Long-Term Eye Health After Vitreous Hemorrhage
A single episode of vitreous hemorrhage increases the risk of future episodes, particularly when an ongoing underlying condition is present. Taking a proactive approach to your overall health and eye care is one of the most important steps you can take.
Because diabetes is the most common cause of vitreous hemorrhage in adults, maintaining good blood sugar control is one of the most effective preventive measures available. Working closely with your primary care doctor or endocrinologist to manage blood sugar, blood pressure, and cholesterol directly supports long-term retinal health. Patients with sickle cell disease, retinal vein occlusion, or other contributing conditions should also remain in close communication with their broader medical team.
Patients who have experienced vitreous hemorrhage should continue regular dilated eye exams with a Retina Specialist, even after the bleeding has resolved. Diabetic patients are generally advised to have at minimum an annual dilated exam, or more frequently if active diabetic retinopathy has been diagnosed. Catching changes early gives the best chance of effective intervention.
Any sudden change in vision should be taken seriously, even if you have been evaluated before. A new shower of floaters, flashes of light, a shadow in your peripheral vision, or a rapid drop in vision are all reasons to contact a Retina Specialist the same day, not wait for a scheduled appointment. These symptoms can signal a retinal tear or detachment that needs immediate attention.
Frequently Asked Questions
Below are answers to some of the questions patients most commonly ask about vitreous hemorrhage, along with practical guidance to help you navigate your care.
Yes, recurrence is possible, particularly when the underlying cause has not been fully controlled. Patients with proliferative diabetic retinopathy face the highest risk of repeated bleeds if abnormal blood vessels continue to develop. Treating the root cause, whether through anti-VEGF injections, laser therapy, or vitrectomy, significantly reduces the likelihood of future hemorrhages. This is one of the strongest reasons to pursue ongoing care even after your vision has improved.
For most patients who have not had surgery, air travel is generally not restricted by the hemorrhage itself. However, if a gas bubble was placed inside the eye during vitrectomy, flying is not safe until the bubble has fully reabsorbed, which can take several weeks. Changes in cabin pressure at altitude can cause a gas bubble to expand, raising eye pressure dangerously. Always confirm with your Retina Specialist before flying after any eye surgery.
Do not stop any prescription medication without first consulting both your Retina Specialist and the doctor who prescribed it. Blood thinners can prolong bleeding, but they are often prescribed for serious conditions such as heart disease or stroke prevention. Your Retina Specialist and your primary care doctor or cardiologist should work together to weigh the risks and benefits for your specific situation before any changes are made.
In many cases, once the blood clears, vision can recover well, especially when the retina itself was not damaged. The more important factor is whether the underlying condition caused any permanent harm to the retinal tissue. Retinal detachment, advanced diabetic retinopathy, or prolonged iron toxicity from uncleared blood can each limit visual recovery. This is why early evaluation and treatment of both the hemorrhage and its cause are so essential.
As a general guide, a shadow or curtain moving across your vision, rapid loss of central vision, or a sudden dramatic increase in floaters accompanied by flashing lights should be treated as an emergency and evaluated the same day. A handful of new floaters that appear gradually, without flashing or shadow effects, is still worth reporting promptly but may not require an emergency visit. When in doubt, it is always safer to call and be seen than to wait and monitor at home, since early intervention can prevent a manageable problem from becoming a vision-threatening one.
Vitreous hemorrhage is bleeding into the gel-filled space inside the eye, while retinal detachment is when the retina physically lifts away from the back wall of the eye. The two can occur together, especially when a retinal tear bleeds before the retina detaches. A Retina Specialist uses dilated examination and, when needed, ultrasound imaging to distinguish between them. Both are serious conditions, but they require different treatments, which is why an accurate diagnosis matters so much.
See a Retina Specialist at NewView Eye Center
If you have experienced sudden vision changes, new floaters, or any other symptoms that concern you, our team at NewView Eye Center is here to help. We offer thorough evaluation, experienced clinical judgment, and a full range of diagnostic tools to assess your retinal health and guide your next steps. When specialized retinal treatment is needed, we coordinate referrals to trusted retinal surgeons to ensure you receive the right care. Contact our office to schedule an appointment and get the answers and support you deserve.
What our Patients Says
Explore More
Find more information about our doctors, services, and technology that keep your eyes healthy and your vision at its best.
Uveitis: Understanding Eye Inflammation and Protecting Your Vision
Retinal Disease: What Every Patient Needs to Know
Laser Floater Removal: Relief for Bothersome Eye Floaters
Vitrectomy Surgery: What Patients Need to Know
Retinopathy of Prematurity: A Guide for Parents
Retinitis Pigmentosa: Understanding Inherited Vision Loss