Diabetic Vitreous Hemorrhage: When Vision Suddenly Turns Black

Sudden, dark vision due to exploding retinal blood vessels can be terrifying. Discover the rapid rescue protocol, including eye injections or vitrectomy surgery with Dr. Mahmoud Hassan.

Diabetic Vitreous Hemorrhage: When Vision Suddenly Turns Black

Have you ever imagined your vision suddenly turning to complete darkness? This isn't a science fiction scenario; it's a painful reality that diabetic patients may face, especially those with advanced diabetic retinopathy. This sudden and frightening symptom is known as vitreous hemorrhage, an ophthalmological emergency that requires rapid intervention to save as much vision as possible.

In this article, we will delve into the depths of this serious condition, exploring its causes, symptoms, and how it can be effectively managed, with a focus on the role of early diagnosis and specialized treatment provided by Dr. Mahmoud Hassan, a retina and vitreous surgeon, and a key contributor to Mashreq Eye Center in Cairo.

What is Vitreous Hemorrhage?

The vitreous humor is the clear, jelly-like substance that fills the space behind the lens of the eye, making up about two-thirds of the eye's volume. When abnormal blood vessels that grow in the retina of diabetic patients rupture, blood can leak into this vitreous humor. This blood leakage is what is known as vitreous hemorrhage.

Perhaps the most prominent feature of this condition is the rapid onset of symptoms; the patient may wake up to find that a large part of their vision has disappeared, or that there are very dense floaters (flying flies) blocking vision, or they may even see the eye completely black. This sudden change causes panic and anxiety in the patient and necessitates immediate medical consultation.

Diabetes and the Retina: A Dangerous Relationship

Diabetes, if not well-controlled, can negatively affect many body organs, and the eye is among the most affected. The effect of diabetes on the retina is known as diabetic retinopathy. In its early stages, no obvious symptoms may appear, but as the disease progresses, blood vessels in the retina begin to weaken and leak, and in advanced stages (proliferative retinopathy), new, abnormal, and very fragile blood vessels grow.

These new blood vessels are the main source of vitreous hemorrhage. They grow in abnormal places and are often attached to the vitreous humor, making them prone to rupture and bleeding easily with any movement or pressure.

Causes of Vitreous Hemorrhage in Diabetic Patients:

• Proliferative Diabetic Retinopathy: This is the most common cause, where weak and abnormal blood vessels grow in the retina.
• Vitreous Traction: When new blood vessels grow on the surface of the retina, they can attach to the vitreous humor and cause traction on it. Any tear in these vessels due to traction can lead to hemorrhage.
• Reopening of previous wounds: In some cases, bleeding may occur at the site of a previous wound in the retina or blood vessel.
• Eye injuries: Direct trauma to the eye can worsen the condition and increase the likelihood of bleeding.

Symptoms: When Vision Turns Black

As mentioned, the most prominent symptom is a sudden change in vision. This may include:

• Appearance of very dense floaters (flying flies): These may appear as black spots or threads floating in the field of vision.
• Blurry or cloudy vision: Due to the presence of blood in the vitreous humor.
• Sudden loss of vision: This may be partial or complete, and vision suddenly turns black.
• Seeing light flashes: This may be a sign of retinal traction.
• Eye pain: In rare cases, hemorrhage may be accompanied by pain, especially if it develops into another condition such as glaucoma (high eye pressure).

It is important to note that these symptoms require an immediate visit to an ophthalmologist, especially if you are diabetic.

Diagnosis: The First Step Towards Treatment

When a patient presents with these symptoms, the retina specialist performs a thorough eye examination. This includes:

• Visual acuity test: To assess the extent of vision impairment.
• Slit Lamp Examination: To view the front of the eye and assess for any signs of inflammation or hemorrhage.
• Fundus Examination: This is the most important examination, where drops are used to dilate the pupil, and then the retina and vitreous humor are examined using an ophthalmoscope or special lenses. This allows the doctor to see the blood in the vitreous humor, assess the condition of the retina, identify the source of bleeding, and assess for the presence of new blood vessels or traction on the retina.
• Ocular Ultrasound: May be necessary in some cases if the hemorrhage is too dense and prevents clear visualization of the retina.
• Optical Coherence Tomography (OCT): To assess the condition of the macula (center of vision) if the hemorrhage allows.

Treatment Options: Restoring Light from Darkness

Treatment depends on the severity and cause of the hemorrhage, and how much vision is affected. The primary goal is to remove blood from the vitreous, treat the underlying cause of the bleeding, and prevent recurrence. Treatment options include:

1. Observation and Waiting (for mild hemorrhages):

If the hemorrhage is very mild and does not significantly affect vision, the doctor may recommend observation, as the body may gradually absorb the blood over weeks or months. However, this option is often unsuitable for diabetic hemorrhages, due to the severity of the underlying condition.

2. Intravitreal Injections:

In some cases, medications such as anti-vascular endothelial growth factor (Anti-VEGF) agents like Eylea or Vabysmo may be injected into the eye. These injections help to shrink abnormal blood vessels and reduce leakage, and can be useful as part of a comprehensive treatment plan, especially if there is also concomitant macular edema.

3. Laser Photocoagulation:

Laser, particularly argon laser, is used in cases of proliferative retinopathy to prevent and shrink the growth of new blood vessels. This procedure is known as Panretinal Photocoagulation (PRP). This may help reduce the risk of future bleeding, but it does not remove blood already present in the vitreous.

4. Vitrectomy Surgery:

This is the most effective treatment for severe or recurrent vitreous hemorrhage. Vitrectomy surgery is a delicate surgical procedure that involves removing blood from the vitreous, as well as any fibrous membranes or bleeding blood vessels. This surgery is often performed using modern techniques such as Microscopic Surgery and Vitrector, and in some cases, may be sutureless (Sutureless Vitrectomy).

When do we resort to vitrectomy surgery? It is usually resorted to when the hemorrhage is severe enough to significantly obscure vision, or when there is traction on the retina, or with recurrent bleeding, or with other complications such as retinal detachment. Vitrectomy surgery step-by-step involves removing the bloody vitreous, then replacing it with clear fluid, gas, or silicone oil depending on the case, and addressing any retinal problems such as tears or detachment.

The estimated price for a simple vitrectomy in Egypt for 2026 is approximately starting from 35,000 EGP. As for the estimated price for a complex vitrectomy / traction / retinal detachment in Egypt for 2026, it is approximately an average of 50,000 EGP. These prices are approximate and depend on the complexity of the case and examination results.

The Role of Dr. Mahmoud Hassan and Al Mashreq Eye Center

In facing this emergency, choosing the right surgeon and specialized medical center becomes paramount. Dr. Mahmoud Hassan, retina and vitreous surgeon, possesses extensive experience in diagnosing and treating complex retinal diseases, including vitreous hemorrhage caused by diabetes. As a key contributor to Al Mashreq Eye Center in Cairo, he ensures comprehensive medical care using the latest technologies and equipment.

Dr. Hassan believes in the importance of clear communication with the patient and explaining all available treatment options, focusing on achieving the best possible results to restore vision and protect the eye from further deterioration. The best retina surgery center in Cairo is one that combines expertise, efficiency, and advanced techniques, which is what Al Mashreq Eye Center always strives for.

Prevention is Better Than Cure

The best way to avoid vitreous hemorrhage is to prevent diabetic eye complications. This includes:

• Strict control of blood sugar levels: Maintaining sugar levels within the normal range as much as possible.
• Monitoring and effectively controlling blood pressure and cholesterol.
• Regular eye examinations: Diabetics should undergo a comprehensive eye examination at least once a year, or as recommended by their doctor, for early detection of diabetic retinopathy. The importance of regular fundus examination for patients with high blood pressure, diabetes, and high cholesterol cannot be overlooked.
• Adopting a healthy diet and exercising regularly.
• Quitting smoking.

Paying attention to eye health as an integral part of diabetes management is key to maintaining healthy vision and avoiding such emergencies.

If you experience any sudden change in vision, or if you are a diabetic patient concerned about your eye health, do not hesitate to seek specialized help. Vitreous hemorrhage in diabetic patients, its causes and treatment, requires a quick and effective response.

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