Vitreous Hemorrhage: Symptoms, Causes, and Care Options
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A vitreous hemorrhage is bleeding into the vitreous, the clear gel filling the eye, causing sudden but painless vision loss, new floaters or hazy sight. [1] Causes include injury, retinal tears or detachment, diabetes-related retinopathy and high blood pressure. [1] Treatment targets the cause with observation, laser, medication or vitrectomy [1] [2], and sudden vision changes need prompt evaluation by an eye specialist.
What the research says
Treatment is built around the cause. A review of vitreous hemorrhage found that it is associated with conditions such as proliferative diabetic retinopathy, retinal vascular occlusion, vasculitis, trauma, retinal breaks, and posterior vitreous detachment. Options include observation, laser photocoagulation, cryotherapy, anti-VEGF injections, and surgery, with pars plana vitrectomy remaining the cornerstone of management. Complications include glaucoma and proliferative vitreoretinopathy (Shaikh et al., Indian J Ophthalmol, 2023) [2].
Injections and surgery gave similar vision after 2 years. In a randomized trial of 205 adults with vitreous hemorrhage from proliferative diabetic retinopathy, mean vision scores over 24 weeks were 59.3 with aflibercept versus 63.0 with vitrectomy plus panretinal photocoagulation (adjusted difference -5.0, 95% CI -10.2 to 0.3, P = .06). Vision was better with surgery at 4 weeks (62.3 with surgery versus 52.6 with aflibercept), but similar at 2 years (73.7 with aflibercept versus 71.0 with surgery), and 33% of eyes assigned to aflibercept later received vitrectomy (Antoszyk et al., JAMA, 2020) [3].
Anti-VEGF can cut re-bleeding after surgery. A Cochrane review of 12 randomized trials (654 eyes) found that bevacizumab given before or during vitrectomy for proliferative diabetic retinopathy reduced early postoperative vitreous cavity hemorrhage (risk ratio 0.28, 95% CI 0.08 to 0.96, 144 eyes) and hemorrhage of all grades (risk ratio 0.35, 95% CI 0.23 to 0.53, 512 eyes) (Smith and Steel, Cochrane Database Syst Rev, 2015) [4].
What Is a Vitreous Hemorrhage?
A vitreous hemorrhage happens when damaged blood vessels leak blood into the vitreous body. The vitreous is a clear, gel-like substance that is firm enough to help the eye hold its globe-like shape and that lets light pass through to the retina. When blood enters this space, it blocks that light and causes sudden vision disruption. Because there are many possible causes, finding the underlying cause is a top priority before treatment. [1]
Symptoms of Vitreous Hemorrhage
The main symptom is a sudden change in vision. Unlike many other eye injuries, vitreous hemorrhage is typically painless, and it usually does not cause visible bleeding at the front of the eye. [1]
Common Vision Disruptions
Sudden vision loss: deterioration can range from mild blurring to a major loss of sight in the affected eye.
Floaters: new spots, cobwebs, or dark streaks in your field of vision.
Hazy or cloudy sight: vision may look as if you are seeing through fog or smoke.
No outward signs: others usually cannot see anything wrong with your eye, and there is no pain. [1]
Causes and Risk Factors
Vitreous hemorrhage happens when blood vessels in the eye leak into the vitreous. There are two main routes: mechanical force or an underlying disease.
Mechanical and Physical Causes
Cause type | Description |
Direct injury | Blunt impacts or sharp objects; the most common cause in people under 40. [1] |
Interior separations | The vitreous pulling away from the retina, as in posterior vitreous detachment (PVD), retinal tears, or retinal detachment, can strain and break connecting blood vessels. [1] |
Sharp movements | Forceful shaking, such as in shaken baby syndrome, can break blood vessels inside an infant's eyes. [1] |
Overpressure | Too much pressure in the head or eye, such as from the Valsalva maneuver or from sneezing or coughing incorrectly. [1] |
Underlying Medical Conditions
Diseases that weaken blood vessels in the eye or disrupt how they work can lead to bleeding. It is more likely in people with diabetes-related retinopathy. [1] Other conditions include:
Diabetes-related retinopathy and type 2 diabetes: fragile new vessels can grow and leak.
High blood pressure (hypertension): chronic high pressure strains the vessels of the eye. [1]
Retinal vein occlusion: blockages that raise pressure in retinal vessels. [1]
Blood disorders: sickle cell disease, anemia, or hemophilia. [1]
Vessel-damaging conditions: such as vasculitis, and eye cancers. [1]
Wet age-related macular degeneration: abnormal vessels that leak. [1]
Diagnosis and Evaluation
An eye care specialist can usually see the bleeding with an ophthalmoscope or a slit lamp exam, which gives a microscopic view of the inside of the eye. [1] Because the cause matters so much, they may also order other tests.
Diagnostic Tools
Ultrasound: sound waves used to look inside the eye when blood blocks the view. [1]
Optical coherence tomography (OCT): a low-power laser that makes detailed pictures of the back of the eye and its blood vessels. [1]
Blood tests: check blood sugar and look for problems such as anemia or clotting disorders. [1]
CT or MRI scans: check whether pressure from the brain is affecting blood vessels in the eye. [1]
Treatment and Management
Treatment depends on how severe the bleeding is and what caused it, and sometimes more than one approach is used. Treating the underlying condition helps the eye heal and helps prevent future bleeds.
Common Treatment Approaches
Treatment type | Action taken |
Conservative | Waiting for several days and watching for change, with rest and no strenuous activity, while the body repairs the cause and clears the blood. [1] |
Focal therapy | Heat, cold, or lasers to seal leaking vessels or repair retinal tears. |
Medication | |
Vitrectomy | Surgery to remove the blood-filled vitreous and replace it with saline, silicone oil, or a gas bubble. [1] |
Treating the cause | Managing conditions such as diabetes or high blood pressure that cause or contribute to bleeding. [1] |
Outlook and Recovery
How long a vitreous hemorrhage lasts depends on its cause, how severe it is, and your treatment. It can take days or weeks for vision to return to how it was before. [1] Blood can settle to the bottom of the eye and the body can slowly clear it, but this takes time. The outlook depends on the cause and on how quickly you get care, and chronic conditions such as type 2 diabetes or macular degeneration tend to have worse outcomes. [1]
Prevention
Most vitreous hemorrhages cannot be predicted or fully prevented, but you can lower your risk by wearing safety glasses or goggles to prevent injuries, getting regular checkups to catch conditions such as type 2 diabetes early, managing chronic conditions such as diabetes and high blood pressure, and having regular eye exams if you are at risk. [1]
When to See a Provider
If you have sudden, painless vision loss, new floaters, or cloudy vision, contact an eye care specialist right away for an urgent evaluation. You cannot diagnose or treat vitreous hemorrhage yourself.
Frequently Asked Questions
1. Does a vitreous hemorrhage hurt?
No. The bleeding itself is typically painless, although the underlying cause, such as an injury, might cause discomfort.
2. Can I see the blood in the mirror?
Usually not. The bleeding is deep inside the eye and does not show on the white or colored part of the eye.
3. Is vision loss from vitreous hemorrhage permanent?
Vision loss from vitreous hemorrhage can be, but many cases are treatable. The outcome depends on the underlying cause and how quickly you get care.
4. What are floaters?
Floaters are small specks, cobwebs, or dark streaks that drift through your field of vision. They can be caused by blood or debris in the vitreous.
5. How long does it take to recover?
It can take days or weeks for vision to return to how it was before, depending on the cause, the severity, and the treatment you receive.
6. Can I prevent a vitreous hemorrhage?
A vitreous hemorrhage is not always predictable, but you can lower your risk by wearing eye protection and managing conditions such as diabetes and high blood pressure.
7. What is a vitrectomy?
A vitrectomy is a surgery in which the vitreous gel is removed from inside the eye and replaced with saline, silicone oil, or a gas bubble.
8. Can diabetes cause eye bleeding?
Yes. Diabetes-related retinopathy can cause fragile new blood vessels to grow and leak into the eye.
9. Is it an emergency?
Sudden, painless vision loss needs medical attention as soon as possible so that serious causes such as a retinal tear or detachment are not missed.
10. Can coughing cause eye bleeding?
Rarely. Too much pressure inside the head or eye, such as from forceful or incorrect coughing or sneezing, can break a blood vessel.
11. What is the Valsalva maneuver?
The Valsalva maneuver is a breathing technique, bearing down against a closed airway, that raises pressure inside the head and eye and can sometimes break a blood vessel.
12. Will the blood go away on its own?
Sometimes. The body can slowly remove blood from the vitreous, and it can settle to the bottom of the eye, but you still need an eye specialist to find and treat the cause.
13. What happens if I do not treat it?
Untreated bleeding and its causes can lead to permanent vision loss or complications such as glaucoma.
14. Are both eyes usually affected?
Usually only one eye is affected at a time, unless both eyes were injured or both have a disease such as diabetic retinopathy.
15. Can children get vitreous hemorrhages?
Yes, often because of injury or, in infants, forceful shaking such as in shaken baby syndrome.
Trusted External Resources
References
Cleveland Clinic. Vitreous Hemorrhage. Cleveland Clinic. Last updated December 23, 2024. https://my.clevelandclinic.org/health/diseases/vitreous-hemorrhage
Shaikh N, Srishti R, Khanum A, et al. Vitreous hemorrhage: causes, diagnosis, and management. Indian J Ophthalmol. 2023;71(1):28-38. PMID 36588205. https://doi.org/10.4103/ijo.IJO_928_22
Antoszyk AN, Glassman AR, Beaulieu WT, et al. Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy: a randomized clinical trial. JAMA. 2020;324(23):2383-2395. PMID 33320223. https://doi.org/10.1001/jama.2020.23027
Smith JM, Steel DHW. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2015;(8):CD008214. PMID 26250103. https://doi.org/10.1002/14651858.CD008214.pub3
Medical Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.
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