Vitreous Hemorrhage: A Patient-Centered Guide to Causes, Symptoms, and Advanced Treatment in Delhi

When a patient walks in saying, “Doctor, I suddenly see floaters, clouds, or even darkness in my vision,” one of the important conditions we consider is vitreous hemorrhage.

Let’s walk through this together in a simple, practical way and discuss about vitreous hemorrhage causes, symptoms and treatment options available in Delhi.

What is Vitreous Hemorrhage?

Inside your eye, there is a clear gel called the vitreous. It helps maintain the eye’s shape and allows light to pass through to the retina.

A vitreous hemorrhage occurs when blood leaks into this gel.

Since the vitreous is normally transparent, even a small amount of blood can disturb vision significantly.

What Do Patients Usually Experience?

Patients often describe symptoms in their own words like:

• “Sudden black spots or floaters”

• “Cobweb-like shadows”

• “Blurred or hazy vision”

• “A reddish or smoky tint in vision”

• “Sudden drop in vision in one eye”

In more severe cases:

• Vision may become very dim or almost completely blocked

 Important point: Most vitreous hemorrhages are painless, which is why they can feel more alarming.

Why Does Vitreous Hemorrhage Happen?

This is where understanding the cause becomes very important.

Common causes include:

1. Diabetic Retinopathy (Most Common)

In diabetes, fragile abnormal blood vessels can form in the retina. These can bleed easily into the vitreous.

2. Retinal Tear or Detachment

A small tear in the retina can disrupt blood vessels and cause bleeding.

3. Posterior Vitreous Detachment (PVD)

Age-related changes where the vitreous pulls away from the retina, sometimes causing vessel rupture.

4. Eye Injury (Trauma)

Direct injury can lead to bleeding inside the eye.

5. Retinal Vien Occlusion

Blocked retinal veins can result in new retinal vessel formation which can cause hemorrhage.

6. Less Common Causes

   -Inflammatory conditions

   -Blood disorders

   -Certain eye tumors

How Do We Diagnose It?

When you come for consultation, evaluation is very systematic.

• Detailed history

• Vision testing

• Dilated eye examination

• Ultrasound (B-scan): this is extremely useful when blood blocks the view of the retina; the ultrasound waves help assess the status of retina in such a situation

Treatment: Step-by-Step Approach

Now comes the most important part - what do we do next?

Treatment is not the same for everyone. It depends on:

- Cause

- Severity

- Duration

- Patient’s overall eye health

1. Early / Mild Vitreous Hemorrhage

If the bleeding is mild and the retina is stable:

• Observation (many cases clear naturally)

• Head elevation while sleeping

• Avoid heavy activity or strain

• Strict control of diabetes or blood pressure

We monitor regularly to ensure:

• Blood is clearing

• No hidden retinal tear

2. Moderate Cases

If bleeding persists or underlying cause needs treatment:

• Control systemic disease (diabetes, hypertension)

• Sometimes supportive medications are prescribed (though no medicine directly “clears” blood quickly)

Role of Injections (Anti-VEGF)

In conditions like diabetic retinopathy: Intravitreal injections are used

These medications:

• Reduce abnormal blood vessel growth

• Prevent further bleeding

For more details on intravitreal injections, visit here:  https://www.drmayankbansal.com/intravitreal-injections

3. Severe Vitreous Hemorrhage

   -Vision is severely affected

   -Blood is not clearing

   -Retina cannot be visualized

   -Retinal detachment is suspected

Surgery becomes necessary

Vitreous Surgery: What We Do

A procedure called pars plana vitrectomy is performed.

What happens during surgery?

• Blood-filled vitreous gel is removed

• Retina is examined and treated

• Laser may be applied if needed

23G vs 25G vs 27G Vitrectomy: Which is Better?

This is a very common and important question.

These numbers refer to the gauge (size) of instruments used.

1. Better balance of rigidity and flexibility

• 23G instruments (most thick, larger diameter) are more rigid → good control but more traumatic entry, may sometimes need suture at the end of the procedure 

• 27G instruments (most thin, smallest diameter) are very flexible → can bend, making peripheral work harder.

• 25G instruments (intermediate size) provides best of both worlds, adequate rigidity with good closure at the end of surgery not necessitating sutures.

2. Optimal flow rate (fluidics)

• 23G → higher flow but can be more turbulent and less controlled.

• 27G → lower flow → slower vitrectomy, longer surgical time.

• 25G offers efficient flow with good control, improving safety and speed.

3. Smaller incision, faster healing

• Compared to 23G, 25G creates smaller sclerotomies, leading to:

  • Less conjunctival trauma

  • Reduced postoperative inflammation

  • Faster recovery

• While 27G is even smaller, the trade-off is reduced efficiency.

4. Suture less surgery with good wound stability

• 25G wounds are usually self-sealing like 27G, but more stable than 27G in many cases, with lower risk of hypotony compared to poorly constructed 23G wounds.

5. Shorter surgical time

• 27G can prolong surgery due to lower flow and cutter efficiency.

• 25G maintains a good speed without compromising precision.

Recovery After Treatment

• Mild cases → improve over weeks

• Post-surgery → recovery varies from days to weeks

• Vision improves gradually as eye heals

Frequently Asked Questions (FAQs)

1. Will the blood clear on its own?

Yes, in mild cases. But it can take weeks to months.

2. Is vitreous hemorrhage an emergency?

Not always—but it should never be ignored. Early evaluation is crucial.

3. Can it happen again?

Yes, especially if the underlying cause (like diabetes) is not controlled.

4. Is surgery risky?

Vitrectomy is very safe when done at experienced surgeons, infection control and chances of retinal detachment need to be understood. 

5. Will I regain fill vision?

Depends on the cause. If the retina is healthy, outcomes are usually good.

6. Can diabetes control prevent this?

Absolutely. Good sugar control significantly reduces risk.

Final Thoughts

If you suddenly notice floaters, shadows, or blurred vision- don't wait.

Vitreous hemorrhage is not just about blood in the eye; it is often a sign of an underlying retinal issue that needs timely care.

At Claritas Eye and Retina Institute in Delhi, the focus is always on:

• Identifying the root cause

• Choosing the least invasive yet effective treatment

• Preserving long-term vision while tailoring the treatment plan individually to the patient's needs. 

With guidance from experienced specialists at Claritas - Dr. Mayank Bansal, trained at AIIMS New Delhi & The Royal College of Surgeons (FRCS) - we ensure patients receive a personalized treatment plan tailored to both their eye condition and lifestyle.