Eye Hemorrhage: Causes, Symptoms, and Modern Treatment Methods

What is an Eye Hemorrhage and Why is it Dangerous?

An eye hemorrhage is the leakage of blood from blood vessels into various structures of the eye, such as the retina, vitreous body, anterior chamber, or under the conjunctiva. These conditions can range from relatively harmless, such as a subconjunctival hemorrhage, to extremely dangerous and vision-threatening, such as central retinal artery occlusion or neovascular glaucoma [2, 3, 6]. The danger lies in the fact that blood can block light, damage sensitive eye structures, and cause an increase in intraocular pressure (IOP), ultimately leading to irreversible vision loss [2, 5].

Main Causes of Vascular Disorders and Eye Hemorrhages

Vascular pathologies are a key factor in the development of many serious eye diseases that lead to hemorrhages.

• Neovascular Glaucoma (NVG)

  NVG is a severe and often blinding disease characterized by the growth of new abnormal blood vessels on the iris and in the anterior chamber angle of the eye [2, 8]. These vessels can cause scarring and closure of the eye's drainage system, leading to a sharp increase in intraocular pressure. The main causes of NVG development are ischemic central retinal vein occlusion, diabetic retinopathy, and ocular ischemic syndrome [2, 8]. The prevalence of NVG is increasing, which is partly due to the growing number of people suffering from diabetes mellitus [8].

• Diabetic Retinopathy (DR)

  DR is one of the most frequent complications of diabetes mellitus and a leading cause of NVG [2, 8]. In diabetes, damage to the small vessels of the retina occurs, which can lead to their permeability, hemorrhages, and the growth of new, defective vessels (proliferative DR) [7]. These new vessels are very fragile and bleed easily, and they can also cause tractional retinal detachment. A key role in the pathogenesis of DR is played by the increased expression of vascular endothelial growth factor (VEGF) [7].

• Central Retinal Artery Occlusion (CRAO)

  CRAO is a vision-threatening emergency that often leads to irreversible monocular vision loss [3, 6]. It is characterized by sudden, painless vision loss in one eye [3]. The cause of CRAO is often systemic factors, such as severe hypertension, extensive cardiovascular disease, or thromboembolism [3]. In rare cases, CRAO can be a complication after eye surgery, such as after scleral buckling for retinal detachment [6].

• Glaucoma in Retinopathy of Prematurity (ROP)

  Glaucoma in children with retinopathy of prematurity (ROP) represents a complex problem. It is usually secondary and may be associated with the closure of the anterior chamber angle of the eye in late stages of ROP (stage 5) [1]. Glaucoma in ROP can manifest significantly later in life, so lifelong monitoring of such patients is necessary [1]. There are isolated reports of glaucoma development after anti-VEGF injections for the treatment of ROP, but convincing evidence is currently insufficient [1].

• The Role of Blood Pressure

  Although elevated intraocular pressure is an established modifiable risk factor for glaucoma, up to 40% of patients develop glaucoma without an increase in IOP [5]. Nevertheless, changes in blood pressure control can negatively affect optic nerve function [5]. High blood pressure is also a significant risk factor for central retinal artery occlusion [3].

Warning Symptoms: When to See a Doctor Urgently?

Hemorrhages and vascular disorders in the eye often manifest suddenly and can progress rapidly. It is important to know the symptoms that require an immediate visit to an ophthalmologist:

• Sudden, painless vision loss in one eye [3].
• A sharp decrease in visual acuity or the appearance of a "veil" or curtain before the eye.
• The appearance of "floaters," floating opacities, or a "web" in the field of vision.
• Eye pain accompanied by redness and decreased vision.
• The appearance of a red spot on the white of the eye (sclera), especially if it is extensive or accompanied by other symptoms.
• A change in the size or shape of the pupil.

Diagnosis of Vascular Pathologies of the Eye

Early and accurate diagnosis is critically important for preserving vision in vascular eye pathologies [2, 8].

• Ophthalmoscopy (fundus examination): Allows detection of changes in the retina, such as diffuse retinal pallor, arteriolar narrowing, the "cherry-red spot" sign in CRAO [3, 6], as well as new vessels on the iris and in the anterior chamber angle in NVG [8].
• Measurement of Intraocular Pressure (IOP): Elevated IOP is a key sign of glaucoma, including NVG [2, 5].
• Optical Coherence Tomography (OCT) and OCT-Angiography (OCTA): These modern methods allow detailed visualization of retinal structures, detection of ischemia and new vessels in early stages, and tracking of disease progression and treatment response [8].
• Fluorescein Angiography: Helps assess blood flow in retinal vessels and identify areas of ischemia or leakage [6].
• Screening for Concomitant Diseases: Includes measuring blood pressure, blood tests for sugar, lipid profile, and other studies to identify systemic causes such as diabetes or hypertension [3, 5].

Modern Methods of Treatment for Hemorrhages and Their Consequences

Treatment of vascular eye pathologies aims to eliminate the cause, control intraocular pressure, and prevent further vision loss.

• Drug Therapy

  Injections of drugs that block vascular endothelial growth factor (VEGF) are the cornerstone in the treatment of diabetic retinopathy and neovascular glaucoma [7, 8]. These medications help reduce the growth of abnormal vessels and decrease retinal edema [7]. Eye drops or systemic medications are used to control high intraocular pressure in glaucoma [1, 2]. It is extremely important to control systemic diseases such as diabetes mellitus and arterial hypertension to prevent the progression of ocular complications [2, 3, 5].

• Laser Treatment

  Panretinal photocoagulation (PRP) is used to destroy ischemic areas of the retina that stimulate the growth of new vessels, thereby reducing the risk of hemorrhages and the progression of NVG [8].

• Surgical Treatment

  Vitrectomy involves the removal of blood from the vitreous body in massive hemorrhages, as well as the removal of fibrovascular membranes in proliferative diabetic retinopathy. Various types of antiglaucoma surgery, such as trabeculectomy or shunt procedures, are performed to create a new outflow pathway for intraocular fluid and lower IOP, especially in neovascular glaucoma [1, 2].

Prevention and the Importance of Long-Term Monitoring

Preventing the development of vascular eye pathologies and their complications includes:

• Careful control of systemic diseases: regular monitoring and treatment of diabetes mellitus, arterial hypertension, and cardiovascular diseases [2, 3, 5].
• Regular ophthalmological examinations: especially important for patients with risk factors such as diabetes, hypertension, or a history of prematurity. Patients with ROP require lifelong monitoring [1].
• Timely medical attention: upon the appearance of any alarming symptoms related to vision, an ophthalmologist must be consulted immediately.

Sources

1. Glaucoma in retinopathy of prematurity: a review. https://pubmed.ncbi.nlm.nih.gov/40147616/
2. Neovascular glaucoma. https://pubmed.ncbi.nlm.nih.gov/17690002/
3. Central retinal artery occlusion associated with abemaciclib and lenalidomide in a patient with breast cancer and multiple myeloma: a potential treatment-related link. https://pubmed.ncbi.nlm.nih.gov/42805625/
4. Blood pressure and glaucoma: at the crossroads of cardiology and ophthalmology. https://pubmed.ncbi.nlm.nih.gov/30882185/
5. Case report: Central retinal artery occlusion following scleral buckling with secondary angle-closure glaucoma and recurrent acute ocular hypertension. https://pubmed.ncbi.nlm.nih.gov/42465073/
6. Advances in the management of diabetic retinopathy. https://pubmed.ncbi.nlm.nih.gov/31669065/
7. Neovascular glaucoma – a review. https://pubmed.ncbi.nlm.nih.gov/33595466/

The information presented in this article is for reference purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.