# Vitreous Haemorrhage > Vitreous haemorrhage for MBBS Ophthalmology: sudden floaters and vision loss, PDR and Eales disease, B-scan when no fundus view, PPV timing. - Canonical URL: https://prepelephant.com/topics/mbbs/ophthalmology/vitreous-haemorrhage - Exam / course: MBBS · Subject: Ophthalmology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Vitreous Haemorrhage", PrepElephant, https://prepelephant.com/topics/mbbs/ophthalmology/vitreous-haemorrhage ## Direct answer Vitreous haemorrhage is bleeding into the vitreous cavity, presenting as sudden painless floaters — "cobwebs", "soot", or a red haze — with visual loss ranging from mild blur to perception of light, and a fundus view that is reduced or abolished with a poor or absent red reflex. The major causes are proliferative diabetic retinopathy (the commonest worldwide and in India), a retinal tear or posterior vitreous detachment in the older eye, trauma, vein occlusion, macroaneurysm, sickle cell retinopathy and Eales disease — the last a periphlebitis of young Indian men presenting with recurrent vitreous haemorrhages. When no fundus view exists, B-scan ultrasonography rules out retinal tear, detachment and tumour; management is upright rest with avoidance of anticoagulants, treating the underlying retinopathy with photocoagulation when the view allows, and pars plana vitrectomy for non-clearing haemorrhage, traction or detachment. ## What you must remember - **Presentation:** sudden painless floaters and decreased vision; a "shower" of dark spots with flashes suggests a retinal tear until proved otherwise; vision may be 6/6 behind a small bleed or hand movements behind a dense one — pain is absent unless there is accompanying pathology. - **Causes by demographic:** older patient — posterior vitreous detachment with retinal tear, branch vein occlusion, exudative macular degeneration; younger patient — proliferative diabetic retinopathy (the largest single cause in India), Eales disease, sickle cell retinopathy, trauma; any age — penetrating injury, and Terson syndrome (sub-internal limiting membrane blood after subarachnoid haemorrhage — check the neurology, and remember bilateral paediatric haemorrhage with abuse). - **Eales disease:** idiopathic retinal periphlebitis of young healthy men, with sheathing of peripheral veins, capillary non-perfusion and recurrent vitreous haemorrhages; managed with sector photocoagulation and vitrectomy for non-clearing bleeds — an examinable Indian entity. - **The B-scan rule:** no fundus view means ultrasound, serially if needed — to exclude retinal detachment (which changes timing to urgent surgery), a concealed retinal tear, or an intraocular tumour bleeding into the vitreous. - **Conservative management:** upright posture to let blood settle, avoidance of aspirin and anticoagulants where possible, and scheduled review — a dense bleed may take weeks to months to clear. - **Laser the cause when possible:** panretinal photocoagulation through a partial haemorrhage in proliferative diabetic or Eales disease removes the neovascular drive that will otherwise re-bleed. - **Surgery indications:** non-clearing haemorrhage (commonly beyond one to three months), associated tractional or rhegmatogenous retinal detachment, macular traction, rubeosis, or an undiagnosable fundus despite ultrasound. - **Signs at the slit lamp:** dull red reflex, cells and layered blood in the anterior vitreous, and ghost-cell glaucoma — a late pressure rise when degenerated red cells block the trabecular meshwork. ## How to work through a "curtain of black blobs" A 34-year-old man who has never seen a physician reports sudden "soot-like" floaters and vision of 6/36 for two days, no pain, no trauma. Establish the systemic frame — random glucose and blood pressure, because silent proliferative retinopathy is the leading possibility in India; examine the periphery of both eyes with indirect ophthalmoscopy and indentation, since Eales and diabetic proliferative disease are frequently bilateral. The right eye view is hazy but present: sheathed peripheral veins with haemorrhages and pale avascular periphery — Eales disease. Photograph and plan sector photocoagulation of the ischaemic periphery once the blood settles, upright posture meanwhile. Contrast the emergency variant: a 65-year-old with flashes preceding a floaters shower and a B-scan showing a mobile posterior vitreous with an operculated superior tear and shallow subretinal fluid — that combination is urgent laser or vitrectomy-buckling surgery, because the tear has declared itself and the retina is beginning to lift; the two cases share the symptom and split on the ultrasound that stands between watchful waiting and the operating theatre. ## Where students slip The first error is prescribing "rest and review" for every vitreous haemorrhage without ultrasound: the unseen retinal detachment under a dense bleed is the complication that converts a recoverable eye to a blind one, and serial B-scans are the standard of care. The second is forgetting Terson syndrome in the confused patient after subarachnoid haemorrhage — bilateral vitreous haemorrhage there is a recognised association and ophthalmology may be the first service to detect the neurologic event. The third is missing ghost-cell or haemolytic glaucoma in the follow-up: a haemorrhagic eye with rising pressure weeks later is not a re-bleed by default, and the anterior chamber full of khaki-coloured cells names it. ## Frequently asked questions ### What is the commonest cause of vitreous haemorrhage in India? Proliferative diabetic retinopathy, with ruptured neovascularisation; Eales disease is the classic cause in young non-diabetic men with recurrent unilateral or bilateral bleeds. ### Which investigation is mandatory when the fundus cannot be visualised? B-scan ultrasonography — to detect retinal detachment, a hidden retinal tear, or an intraocular mass, repeated serially while the haemorrhage clears. ### What is Eales disease? An idiopathic obliterative retinal periphlebitis of young adults, predominantly Indian men, causing peripheral venous sheathing, ischaemia, neovascularisation and recurrent vitreous haemorrhages. ### When is vitrectomy indicated for vitreous haemorrhage? Non-clearing haemorrhage over roughly one to three months, associated tractional or rhegmatogenous detachment, macular traction, rubeosis, or an undiagnosable fundus despite imaging. ### What is ghost-cell glaucoma? A late pressure rise after vitreous haemorrhage in which degenerated, less-pliable red blood cells migrate into the anterior chamber and obstruct trabecular meshwork outflow.