Understanding Retinal Bleeding
Retinal bleeding, also called retinal hemorrhage, occurs when blood vessels within the retina leak or rupture. The retina is the light-sensitive tissue at the back of the eye that is essential for vision. When bleeding happens in this area, it can interfere with the transmission of visual signals to the brain and may lead to blurred vision, floaters, or even permanent vision loss if left untreated. The best way to stop retinal bleeding depends on the underlying cause, the severity of the bleeding, and the overall health of the eye.
Causes of Retinal Bleeding
There are several possible causes of retinal bleeding. Diabetic retinopathy is one of the most common, in which prolonged high blood sugar damages small retinal blood vessels, making them fragile and prone to leakage. Hypertensive retinopathy is another common cause, resulting from chronic high blood pressure that weakens vessel walls. Retinal vein occlusion, or blockage of a retinal vein, can also lead to bleeding. Other possible causes include trauma, age-related macular degeneration, blood disorders, or ocular conditions that affect circulation within the eye.
Diagnosis of Retinal Bleeding
An eye care provider diagnoses retinal bleeding through a comprehensive dilated eye exam. During the exam, the retina is examined directly using ophthalmoscopy. Additional imaging such as optical coherence tomography may be used to assess retinal thickness and swelling. Fluorescein angiography can help detect areas of leakage or blocked vessels. Accurate diagnosis of the cause is essential because treatment focuses on controlling the underlying disease and preventing further bleeding.
Managing Retinal Bleeding from Diabetic Retinopathy
In diabetic retinopathy, retinal bleeding often results from abnormal new blood vessel growth, also known as proliferative diabetic retinopathy. Treatment typically involves intravitreal injections of anti-vascular endothelial growth factor medications. These medications reduce abnormal vessel growth and help stabilize existing vessels to prevent further bleeding. Laser photocoagulation may also be used to seal off leaking blood vessels and reduce the oxygen demand of the retina. In cases where bleeding is extensive and blood accumulates in the vitreous cavity, a surgical procedure called vitrectomy may be necessary to remove the blood and prevent scar tissue from damaging the retina.
Managing Retinal Bleeding from Hypertension
When retinal bleeding is caused by uncontrolled high blood pressure, the most important step is to control systemic hypertension. Lifestyle changes and blood pressure medications prescribed by a primary care provider or cardiologist are critical to reduce stress on the retinal vessels. Once blood pressure is controlled, retinal bleeding may stabilize or improve over time. In some cases, additional ophthalmic treatments may be required if the bleeding has caused swelling or secondary complications.
Managing Retinal Bleeding from Retinal Vein Occlusion
Retinal vein occlusion occurs when one of the veins draining blood from the retina becomes blocked. This can cause sudden bleeding and swelling of the retina. Treatment may include anti-vascular endothelial growth factor injections or steroid injections into the eye to reduce swelling and leakage. Laser treatment may also be used to manage abnormal vessel growth. Addressing systemic risk factors such as hypertension, diabetes, or high cholesterol is equally important to prevent recurrence.
Managing Retinal Bleeding from Trauma or Other Causes
Trauma to the eye can cause sudden bleeding in the retina. Management depends on the severity of the injury. Minor bleeding may resolve on its own, while significant hemorrhage may require surgical intervention such as vitrectomy. Blood disorders that increase bleeding risk, such as anemia or clotting disorders, may need to be managed in coordination with a hematologist. In cases related to age-related macular degeneration, anti-vascular endothelial growth factor injections are often used to reduce further bleeding from abnormal vessels under the macula.
Prognosis After Retinal Bleeding
The visual prognosis after retinal bleeding depends on the location and extent of the hemorrhage as well as how quickly treatment is initiated. Bleeding that occurs away from the central macula may have minimal long-term impact, while bleeding directly affecting the macula can cause permanent vision loss. Early detection and prompt treatment improve the likelihood of preserving vision. Regular follow-up with an eye care provider is essential to monitor for recurrence or progression of disease.