In medical conditions such as diabetes, peripheral neovascularization, or sickle cell disease, obtain a consultation within 48 hours and treat the patient as an outpatient. Discharge instructions must include limiting physical activity and sleeping in an upright position. Studies in diabetic retinopathy with vitreous hemorrhage found no benefit, as far as preventing further or recurrent hemorrhage, from discontinuing aspirin therapy. Do not discharge patients from the ED until a time and date for the consultation is available. Follow-up care should confirm that the patient saw a consultant.
Ophthalmologic consultation is mandatory in vitreous hemorrhage.
A retinal specialist usually is necessary for medical and surgical intervention. Treatment of vitreous hemorrhage depends upon the underlying cause. In retinal tears or detachment, laser cryotherapy or scleral buckle surgery is indicated. With underlying medical diseases, treat the patient conservatively with upright positioning for sleep to enhance settling of the hemorrhage. With the exception of trauma and retinal detachment, close observation for 1-2 weeks allows time for spontaneous clearing of the hemorrhage.