Floaters from Vitreous Hemorrhage

Vitreous hemorrhage from various causes can cause floaters.

Vitreous hemorrhage can cause floaters in the eye.  Bleeding inside the eye is called vitreous hemorrhage.  Symptoms of this type of bleeding range from a showere of floaters to incomplete darkness (lots of blood).

Floaters due to blood can not be distinguished by other types of floaters based upon appearance.  Often floaters from hemorrhage have appeared suddenly and don’t necessarily last as long as chronic (long-lasting) floaters, but they can.

Causes of Vitreous Hemorrhage

Any bleeding into the vitreous is called vitreous hemorrhage.  Hence, there are a variety of causes of bleeding into the vitreous;

  1. Retinal tears
  2. Retinal Detachments
  3. Trauma
  4. Diseases of the retina (eg. proliferative diabetic retinopathy)
  5. Complications of retinal vascular disorders
  6. Posterior Vitreous Detachment

Treatments

For all intents and purposes, blood in the vitreous does not cause long-lasting damage. It is most important to establish the underlying cause of the bleeding and treat that disorder whenever possible. 

For dense vitreous hemorrhages, it may indeed be prudent to consider a vitrectomy to remove the blood to restore vision, but more importantly, and to allow the retina specialist to perform a thorough examination of the eye with the blood removed.

Retinal Tears and Bleeding

As an example, a retinal tear can cause a vitreous hemorrhage if the tear rips across a retinal blood vessel and causes bleeding.  There may be too much blood to actually visualize a retinal tear.  Keep in mind, retinal tears can lead to retinal detachments.

Retinal detachments can be potentially blinding and, in cases of all retinal tears, we would like to treat the tear before a retinal detachment develops.

Vitreous Hemorrhage Can Resolve

Blood in the vitreous usually absorbs and can clear on with a vitrectomy.  There is no specific timing of this and it can take weeks or even months.  Sometimes, blood does not clear on its own and vitrectomy may be necessary. 

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

What is FOV?

FOV stands for Floater Only Vitrectomy.  In my experience, this is the common name of the basic operation performed by a retina specialist called vitrectomy.

Vitrectomy and FOV, therefore, are synonyms.  Vitrectomy is the standard operation performed by all retina specialists (for all reasons) whereas FOV refers to a vitrectomy performed for the removal of only (just) floaters.

Vitrectomy

Vitrectomy is the operation to remove the vitreous.  The vitreous is the gel-like substance that fills the back of the eye.  

The vitreous may be removed;

  • To remove a vitreous hemorrhage (blood)
  • Remove a foreign body
  • Repair
    • Retinal detachment
    • Macular hole
    • Epiretinal membrane
  • Remove floaters

Types of FOV or Vitrectomy

All modern types of FOV are basically the same.  They involve the creation of 3 holes in the eye:

  1. Left hand
  2. Right hand
  3. Infusion port to keep the eye filled with saline during the operation

There are slight changes in nomenclature to distinguish the size or thickness of the instruments used to enter the eye.  The size of the sclerotomies (holes) the instruments create naturally vary in size.  The thicker instruments create large holes and vice versa.  20 gauge instruments are the thickest and require sutures to close the sclerotomies.  23 and 25 gauge instrumentation create tinier sclerotomies and suture closure is up to the discretion of the retina specialist.

What Replaces the Vitreous?

The vitreous is cut away rapidly in very tiny miniscule pieces and is replaced by artificial saline solution.  As the operation is proceeding, a tube is constantly infusing saline into the eye.  After the operation is complete, your eye replaces the saline with aqueous humor in a matter of a couple days.

How is FOV Different than Vitrectomy

It’s not.  It’s exactly the same.  After the vitreous is removed, the operation is essentially over.  FOV for floaters is exactly the same as FOV for vitreous hemorrhage – the goal of both is to simply clear opacities from the vitreous to create a clear path for vision.

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

What are Eye Floaters?

Vitreous floaters, eye floaters or just floaters can be annoying or a dangerous threat to your vision.

Eye floaters, or vitreous opacities, are common but not always benign. They also affect us all differently, from a mere annoyance to visually impressive.

Floaters are the common name for dark specks or spots which move to and fro in your vision.  They move with eye movement in your field of vision.  They may or may not be associated with clumps or strands of protein floating in your vitreous. These clumps or strands may represent “cob-webs” also seen in your vision.

There are many causes of floaters.

What is the Vitreous?

The vitreous is the substance that fills the vitreous cavity.  The vitreous cavity, or posterior chamber, is the largest compartment of the eye and is located between the lens and the retina.  The retina is the inside lining of the eye. 

Normally, the vitreous is optically clear, color-less and has the consistency of a gel.  The vitreous is composed mostly of water, but has about 5% protein. 

The vitreous is essential for normal embryologic development of the eye.  Once we are born, we are not sure of any true functions of the vitreous although many believe it is essential in oxygenation of the tissues of eye, such as the lens.

The vitreous may absorb energy.  For instance when you are engaged in sports, running, or suffer a head injury, the vitreous may be absorbing shock waves.  This is unproven.

What are floaters?

The vitreous is never regenerated.  While the fluid component does renew (aqueous humor), the proteins do not.  With time and normal aging, the proteins can denature or breakdown and the vitreous becomes more water-like.  

The thinner, more fluid, vitreous means that the vitreous changes from a thicker gel to a more watery substance.  The proteins can more easily coalesce and clump together casting shadows on the retina…more commonly known as floaters. 

Floaters can also be a result of retinal disease, blood or inflammation.  Floaters from any cause are indistinguishable from one another (i.e. you can’t tell the difference between floaters due to blood vs. inflammation).  Only your eye doctor can tell the difference after a thorough dilated examination of your eye.

It is recommended that you alert your eye care professional should you ever experience a sudden increase in floaters.  New floaters could be a sign of a potentially blinding condition. 

Treatment of Floaters

In general, the best treatment for floaters is to treat the underlying disease.  Persistent floaters can be bothersome.  Removal via vitrectomy may be the only solution for clearing the floaters from your vision.

Some doctors may offer Nd:Yag laser for the treatment of floaters.  There are limitations to this type of treatment and not all retina specialists view this treatment equally. 

If you would like to schedule an appointment, please call us (877) 245.2020.

Nader Moinfar, M.D., M.P.H.
Retina Specialist
Orlando, FL

Jon Doe