Bleeding can occur from any structure of the eye where there is vasculature or blood flow, including the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or optic disc.
Hyphema is a result of blunt or penetrating trauma to the orbit that increases intraocular pressure, causing tears in the vessels of the ciliary body and iris.
Less common causes include vascular occlusive disease, retinal arterial macroaneurysm, hemoglobinopathy, age-related macular degeneration, and intraocular tumors.
Significant subretinal hemorrhage occurs in several conditions, but is most commonly associated with age-related macular degeneration, presumed ocular histoplasmosis, high myopia, retinal arterial macroaneurysm, and trauma.
A subconjunctival hemorrhage appears as a bright red patch on the white (sclera) of the eye and is commonly referred to as a burst blood vessel.
Any patient with a hyphema larger than grade II, elevated intraocular pressure, or sickle cell disease—or who is unable to comply with daily ophthalmology evaluations—should be admitted to the hospital.
They are commonly seen in age-related macular degeneration, presumed ocular histoplasmosis, high myopia, polypoidal choroidal vasculopathy (PCV), retinal macroaneurysm, and trauma.
[13] A subconjunctival hemorrhage is diagnosed by visual examination; it will present as a red splotch visible to the naked eye.
One should suspect abusive head trauma if a child younger than three shows retinal hemorrhages with an intracranial injury.
[9] Vitreous hemorrhages are treated by targeting the underlying cause, such as with laser photo-coagulation for proliferative diabetic retinopathy or retinal detachment.
Occasionally, a hemorrhage does not resolve on its own, and vitrectomy surgery—which removes the vitreous and replaces it with a saltwater solution similar to the eye's natural fluids—becomes necessary.
Those that do not obscure or threaten vision can be monitored to evaluate their progression in size and number, but the primary disorder behind the hemorrhages needs to be diagnosed and addressed.
[8] Prognosis depends on the location of the bleed, the amount of bleeding, the rate of clearing of blood, whether the blood is affecting visual acuity, complications (such as corneal staining, retinal detachment, pre-retinal fibrosis, ischemic optic atrophy, or glaucoma), and the severity of involvement of the macular region.
[12] Submacular hemorrhage patients with an otherwise healthy retinal pigment epithelium (RPE) and photoreceptors will recover the most visual function.
The prognosis is often poor in cases of advanced AMD due to underlying RPE disease, even with successful clearing and removal of the hemorrhage.
[12] Submacular hemorrhage typically occurs in elderly patients with exudative age-related macular degeneration, macroaneurysms, or polypoidal choroidal vasculopathy, and in all populations in cases of trauma.
Eighty cases of intraocular hemorrhage (vitreous, choroidal, or retinal) were identified with warfarin in the World Health Organization's Vigibase database from 1968–2015.
[20] The incidence of intraocular hemorrhage is higher with warfarin and new oral anticoagulants than with other drugs in the World Health Organization's database.