What are the different types of retinal hemorrhages?

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Below are the different types of retinal hemorrhage.

Vitreous hemorrhage

The vitreous is the gel-like fluid that fills the eye. It is full of tiny fibers that attach to the retina. A vitreous hemorrhage (VH) occurs when bleeding takes place in the vitreous cavity.

Some health experts may also refer to a VH as a preretinal hemorrage. This type of bleed may be in the shape of a boat or a capital “D.”

A VH will often cause fresh blood clots to appear in the vitreous and may cause a person to experience floaters. Floaters are dots or specks in the vision that appear to float away when a person tries to look at them.

Intraretinal hemorrhage

Intraretinal hemorrhages occur when blood accumulates in the inner nuclear and outer plexiform layers of the retina. This usually happens when there is a tear in the retina itself.

These hemorrhages are often dense and dark red, with a sharp outline. Medical professionals may refer to them as “dot and blot hemorrhages.”

Subretinal hemorrhage

The photoreceptor layer in the eye consists of the light-sensitive pigments in the retina. The retinal pigment epithelium (RPE) is the outer retinal layer that spans the width of a single cell.

Subretinal hemorrhages occur when blood accumulates beneath the RPE. They are often deep red, broader in shape than other types, and have diffuse margins.

Learn about other retinal problems.

Retinal hemorrhages are typically not a medical emergency. In many cases, if a retinal hemorrhage does not obscure or threaten a person’s vision, it will not require immediate medical care.

Retinal hemorrhages that have the shape of a dot, blot, splinter, or flame do not threaten vision and are not a medical emergency. Treatment for retinal hemorrhages will usually involve treating their underlying cause.

However, if a person experiences problems with their vision or the bleeding is the result of trauma, it may be advisable to seek medical assistance.

Retinal bleeding can be a symptom of several other health conditions. Below are some of the health conditions that can cause retinal bleeding:

• Eye diseases: Eye diseases that can cause retinal bleeding include:
  • age-related macular degeneration (AMD)
  • polypoidal choroidal vasculopathy
  • optic disc hemorrhages
• Diabetic retinopathy: This refers to blood vessel damage within the retina that occurs due to diabetes. Diabetic retinopathy can lead to vision loss and blindness.
• Hypertensive retinopathy: This occurs when high blood pressure causes damage to the blood vessels in the eyes. It is a progressive condition that may lead to vision loss.
• Retinal vein occlusions: Retinal vein occlusions occur when a blood clot blocks veins that transport blood out of the retina. In rare instances, blood clots form in the arteries carrying blood to the retina, causing blurry vision. This usually only affects one eye.
• Trauma: Head or eye trauma may cause retinal hemorrhages. For example, infants may develop neonatal retinal hemorrhages due to birth trauma.
• Anemia: Anemia is a medical condition that occurs when there are not enough red blood cells in the body. A person may also develop anemia if the red blood cells they do have cannot carry oxygen throughout the body as well as usual. Symptoms include:
  • fatigue
  • shortness of breath
  • heart palpitations
  • changes in skin color
  • headaches
• Leukemia: Leukemia is the umbrella term for cancers of the blood cells. Different types of leukemia affect different blood cells. Some leukemias are fast-growing, and some are slow-growing.
• Acute bacterial endocarditis: This condition causes inflammation in the heart’s lining due to a bacterial infection. Common symptoms include:
  • fever, chills, and night sweats
  • anorexia, weight loss, and loss of appetite
  • malaise
  • headaches
  • muscle aches and pains
  • joint pain
  • shortness of breath
• Sickle cell anemia: Sickle cell anemia is the term for a group of blood disorders affecting hemoglobin, the protein that carries oxygen throughout the body. Sickle cell anemia can cause a person to experience:
  • jaundice (yellowish skin)
  • extreme fatigue
  • painful swelling of the hands and feet
• Ocular ischemic syndrome: This is a visual function disorder caused by carotid artery stenosis. It can cause visual loss and eye pain.
• Preeclampsia: Preeclampsia is sudden high blood pressure that occurs during pregnancy. It may cause symptoms such as:
  • a persistent headache
  • vision changes
  • stomach pain
  • nausea or vomiting

Symptoms of retinal bleeding vary depending on the type of retinal hemorrhage. However, some common symptoms of retinal bleeding may include blurry vision and the presence of floaters in vision.

Diagnostic signs an ophthalmologist can see include the presence of hemorrhages in the retina or other parts of the eye that may be:

• disc-shaped
• flame-shaped
• boat- or “D”-shaped
• round with a white center

They may have a diffuse or sharp outline and can be deep or dark red.

Retinal hemorrhages often occur due to an underlying medical condition.

During diagnosis, a doctor will want to determine the cause of the bleeding so they can treat this underlying condition.

They will usually begin by measuring a person’s:

• blood pressure
• body mass index (BMI)
• blood sugar levels

They may then conduct further testing to determine the underlying cause.

A retinal hemorrhage that does not obscure or threaten a person’s vision does not require immediate treatment.

A doctor will observe the hemorrhage during a follow-up appointment and track its progression and size. They will aim to diagnose the underlying condition that caused the hemorrhage and devise a treatment plan to treat this condition.

In some cases, a doctor may recommend the following treatment strategy for more serious hemorrhages:

• bed rest with head elevation to reduce further bleeding
• wearing an eyepatch on the affected eye to reduce eye movement
• avoiding using certain drugs, such as aspirin

In some cases, a medical professional may use antivascular endothelial growth factor to help slow or stop bleeding. They may also use laser photocoagulation or cryotherapy to close breaks in the retina.

A person with a detached retina may undergo surgery to reattach it.

Effective treatment of the underlying cause of retinal hemorrhages is the best way to lower a person’s risk of developing a hemorrhage.

A person may also wish to follow these steps to maintain their eye health:

• Undergo a comprehensive dilated eye exam: Medical professionals can check for signs of eye conditions during this procedure. This may help detect issues early on when they are easier to treat.
• Lifestyle changes: Certain conditions can increase a person’s risk of retinal hemorrhages. These include diabetes and high blood pressure. The following can lower the risk of developing these conditions:
  • eating a balanced diet
  • being physically active
  • quitting smoking, if applicable
• Protect the eyes: A person may wish to follow these steps to protect their eyes:
  • wear sunglasses
  • wear protective eyewear when doing certain activities, such as playing sports or doing construction work
  • regularly rest the eyes if looking at a computer screen for long periods
  • wash hands before putting in or taking out contact lenses

A retinal hemorrhage occurs when there is bleeding in the retina. Retinal hemorrhages are often a sign that an underlying condition is present. Types of retinal hemorrhages include vitreous, preretinal, intraretinal, and subretinal hemorrhages.

Certain medical conditions can cause retinal hemorrhages. These include diabetes, high blood pressure, retinal vein occlusions, trauma, anemia, leukemia, and acute bacterial endocarditis.

In many cases, retinal hemorrhages do not require treatment. Instead, medical professionals often diagnose and treat the underlying condition that caused the hemorrhage. In some cases, a doctor may suggest laser photocoagulation or cryotherapy to close breaks in the retina.