Diabetic Vitreous Hemorrhage: Causes and Treatment

Understanding the causes of vitreous hemorrhage in diabetic patients. Dr. Mahmoud Hassan explains when bleeding resolves spontaneously and when vitrectomy surgery is necessary.

Diabetic Vitreous Hemorrhage: Understanding Causes and Treatment Options

Vitreous hemorrhage is a serious complication that can affect the eye, especially in diabetic patients. When this bleeding occurs within the vitreous cavity of the eye, it can obstruct vision and significantly impact the patient's quality of life. In this article, we will delve into understanding the causes of diabetes-related vitreous hemorrhage, how it is diagnosed, and the available treatment options, focusing on the role of Dr. Mahmoud Hassan, a retina and vitreous surgeon, and his experience at El Mashreq Eye Center in Cairo.

What is Vitreous Hemorrhage?

The vitreous is the jelly-like substance that fills the back part of the eyeball, between the lens and the retina. Vitreous hemorrhage means the presence of blood within this jelly-like substance. The amount of blood can range from a few small drops that cause floaters (flying flies) to a dense hemorrhage that completely obstructs vision.

Main Causes of Vitreous Hemorrhage in Diabetic Patients

Diabetes, especially if not well-controlled, can lead to damage to the tiny blood vessels in the retina. This condition is known as diabetic retinopathy. The most prominent causes that lead to vitreous hemorrhage in these patients are:

• Proliferative Diabetic Retinopathy: This is the most advanced stage of diabetic retinopathy. In this stage, weak and fragile new blood vessels grow on the surface of the retina or in the iris. These new vessels (called neovascularization) are highly prone to bleeding. Bleeding can occur either directly from these new vessels or due to their traction by fibrous tissues that may form as a result of diabetes, leading to their rupture.
• Vitreous Traction: In some cases of advanced diabetic retinopathy, fibrous tissues may form and attach to the vitreous and retina. When the vitreous shrinks or these tissues form, they may pull on the retina, leading to the rupture of new blood vessels and bleeding.
• Bleeding from Pre-existing Blood Vessels: In less common cases, bleeding may occur from normal blood vessels in the retina if they are weakened by diabetes.
• Other Non-Diabetic Causes: Although diabetes is the most common cause, vitreous hemorrhage can also occur due to eye injuries, retinal vein occlusion, retinal detachment, or previous eye surgeries.

Symptoms of Vitreous Hemorrhage

Symptoms depend on the amount of blood and its location within the eye. These may include:

• Appearance of Floaters (flying flies): These are black spots or threads that appear in the field of vision and move with eye movement. These floaters may suddenly increase or become noticeably more prominent.
• Seeing Flashes of Light: The patient may experience a sudden flash of light in their field of vision.
• Blurred Vision: Vision may become blurry or cloudy.
• Sudden Vision Loss: In cases of severe hemorrhage, complete or near-complete vision loss may occur in the affected eye.
• Difficulty with Night Vision.

Diagnosis: How Do We Detect Vitreous Hemorrhage?

Accurate diagnosis of vitreous hemorrhage relies on a comprehensive eye examination performed by a specialized ophthalmologist. This includes:

• Visual Acuity Test: To assess the extent of vision impairment.
• Slit Lamp Examination: To evaluate the front part of the eye.
• Fundus Examination: This is the most important part, where the pupil is dilated using special drops, and then the doctor examines the retina and vitreous using an ophthalmoscope or a special magnifying lens. This examination helps identify the presence of blood, its source, and evaluate the condition of the retina and blood vessels.
• Optical Coherence Tomography (OCT): Can help evaluate the presence of macular edema (macula) or other retinal problems.
• Fundus Fluorescein Angiography: Used to identify abnormal new blood vessels and assess the extent of blood or fluid leakage from the vessels.
• B-scan Ultrasound: May be necessary in cases of dense hemorrhage that completely obscures the view of the retina, to identify the presence of retinal detachment or other problems in the back of the eye.

Diabetic Vitreous Hemorrhage Treatment

Treatment depends on the cause and severity of the hemorrhage, as well as the overall condition of the retina. In some cases, the bleeding may resolve spontaneously over time as the body gradually reabsorbs the blood. However, in other cases, medical or surgical intervention may be required.

1. Observation and Conservative Treatment

If the hemorrhage is mild and does not significantly affect vision, and the cause is non-proliferative diabetic retinopathy or an early stage of proliferative retinopathy, the doctor may recommend regular monitoring. Treatment may also include:

• Strict blood sugar control: This is the cornerstone of treating and preventing the progression of diabetic retinopathy.
• Blood pressure and cholesterol level control.
• Retinal Photocoagulation: In cases of proliferative diabetic retinopathy, laser can be used to reduce the growth of abnormal new blood vessels, which helps prevent future bleeding.
• Intravitreal Injections: Medications such as Eylea or Vabysmo can be injected directly into the vitreous to stop the growth of new blood vessels and reduce leakage and bleeding. The cost of intravitreal injection (IVI) depends on the type of medication used, as the price of an Eylea or Lucentis injection in Egypt for 2026 differs from the price of a Vabysmo injection.

2. Vitrectomy Surgery

Vitrectomy surgery is the optimal solution in the following cases:

• Severe hemorrhage that does not improve spontaneously and significantly affects vision.
• Traction on the retina due to fibrous tissue, which increases the risk of recurrent hemorrhage or retinal detachment.
• Retinal detachment accompanying the hemorrhage.
• Severe fibrosis in the vitreous or retina.

During a vitrectomy, the retinal surgeon removes blood and abnormal fibrous tissue from the vitreous. The surgery may also involve other procedures such as removing fibrous membranes, repairing retinal tears, or removing silicone oil if present. This surgery is typically performed using modern techniques such as sutureless vitrectomy with fine instruments (e.g., 23G or 25G), which reduces recovery time and improves outcomes. The cost of a simple vitrectomy in Egypt for 2026 differs from the cost of a complex/tractional/retinal detachment vitrectomy.

Dr. Mahmoud Hassan, a key contributor to Mashreq Eye Center, is a highly experienced retinal surgeon in performing complex vitreous surgeries, including those related to diabetic patients. The center aims to provide the highest level of care to ensure the best possible outcomes for patients.

When Does the Hemorrhage Resolve Spontaneously?

In some cases, especially mild hemorrhage due to diabetic retinopathy, the body may begin to gradually reabsorb the blood over weeks to months. However, the presence of blood in the vitreous for prolonged periods can lead to damage to retinal cells, development of fibrous tissues, or even retinal detachment. Therefore, even if the hemorrhage is mild, follow-up with a retinal specialist is essential to assess the condition and determine if early intervention is necessary.

Recovery After Treatment

The recovery period varies depending on the type of treatment. After injections, the patient may need rest and to avoid strenuous activities for a few days. After vitrectomy surgery, the recovery period is longer and requires strict adherence to the surgeon's instructions, such as specific head positioning, avoiding heavy lifting, and keeping follow-up appointments. Vision recovery after vitrectomy surgery may take some time and depends on the complexity of the case.

Prevention is Better Than Cure

The best way to avoid diabetic vitreous hemorrhage is to prevent the complications of diabetic retinopathy:

• Adherence to treatment and precise control of diabetes.
• Regular eye exams, especially fundus examination, for early detection of any changes in the retina.
• Following a healthy diet and regular exercise.
• Quitting smoking.

Caring for eye health as an integral part of diabetes management can make a significant difference in preserving vision.

For more information on retinal and vitreous surgeries, you can visit .

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