Subretinal hemorrhage is a serious eye condition that can threaten vision, especially when it involves the macula. Our experienced retina specialists at Specialty Vision are dedicated to diagnosing and managing this urgent issue to preserve your eyesight. Schedule an evaluation today for personalized care.
Subretinal hemorrhage involves bleeding beneath the neurosensory retina, a sightâthreatening event that requires prompt evaluation and management. This page presents a comprehensive overview of the condition, its causes, diagnostic methods, and available treatments.
Subretinal hemorrhage is the accumulation of blood beneath the neurosensory retina, presenting as a dark red or grayish lesion during an eye exam. This condition signifies bleeding that occurs between the retinal pigment epithelium (RPE) and the overlying retina, or between the RPE and Bruch’s membrane, making any involvement potentially vision-threatening. Early recognition is essential, and our retina specialists are committed to guiding you through understanding and managing this condition.
At its core, subretinal hemorrhage refers to bleeding confined beneath the neurosensory retina. The blood can settle in different anatomical planes, either just under the retina itself or beneath the pigmented epithelial layer. Whether the hemorrhage is located in the subretinal space or the sub-RPE space can directly affect how it appears during an exam as well as the treatment approach that is recommended.
To understand the impact of subretinal hemorrhage, it’s useful to first dive into its anatomical location. The bleeding occurs in one of two principal planes:
This is where blood accumulates between the neurosensory retina and the RPE.
Here, the blood collects between the RPE and Bruch’s membrane.
The exact placement can influence both how the hemorrhage looks on imaging tests and the overall treatment strategy required for preservation of vision. When the central area of the retina, known as the macula, is involved, the potential for long-term visual impact increases considerably.
During a fundus examination, subretinal hemorrhage can be identified by its distinctive appearance. Here’s what you might expect:
These hemorrhages often appear as irregularly shaped lesions, displaying colors ranging from dark red to gray-green. Some cases might also show accompanying features such as subretinal fluid, exudates, or changes in pigment distribution.
In many instances, especially in eyes affected by nAMD, bleeding involves the macula—the central, vision-critical area of the retina. When central vision is compromised, symptoms become more apparent.
Patients often report sudden and painless central vision loss. Other symptoms include visual distortions (metamorphopsia) and the appearance of blind spots (scotomas). These changes may happen rapidly, and in some cases, patients might not notice the bleed until significant damage has occurred.
The swift onset of these symptoms underlines the importance of prompt evaluation by our retina specialists. If you experience any of these changes in your vision, it’s a strong indicator that further evaluation is needed.
Subretinal hemorrhage primarily occurs due to a rupture in either the choroidal or retinal vessels. The causes behind these ruptures often include underlying retinal or vascular conditions, with several main factors contributing to the event. It is important to be aware of these contributing elements, so you know what signs to look for and when to seek help.
This is one of the most common conditions linked to subretinal hemorrhage. In nAMD, abnormal blood vessels form beneath the retina, which can easily leak or rupture.
A variant of neovascular conditions, PCV is characterized by abnormal, polyp-like blood vessels under the retina that are prone to bleeding.
Direct injury to the eye or head can result in a subretinal bleed due to vessel rupture. Even seemingly minor impacts might create complications when it comes to the delicate structures of the retina.
Severe nearsightedness can stretch and thin the retina, making it more vulnerable to bleeding from even minor vascular disruptions.
Retinal Arterial Macroaneurysm
An abnormal dilation in a retinal blood vessel can predispose the eye to hemorrhage if the vessel ruptures.
This tear in the choroid layer, often related to trauma, may lead to blood accumulating under the retina.
Often associated with intracranial hemorrhage, this syndrome can extend bleeding into the retinal layers.
Systemic conditions like leukemia, anemia, or thrombocytopenia may affect blood clotting and vessel integrity, increasing the risk of spontaneous bleeding in the eye.
Understanding the underlying cause is vital for determining both the urgency of the situation and the management strategies our retina specialists might recommend. Whether the underlying trigger is a common condition like nAMD or a less frequent cause such as trauma or blood disorders, pinpointing the cause is the first step toward preventing further damage.
Diagnosis starts with a comprehensive eye examination and the use of specialized imaging tools. Our retina specialists use multiple modalities not only to detect the presence of a hemorrhage but also to determine its precise location and extent. Here are the key diagnostic tools:
This initial examination allows our retina specialists to directly visualize the hemorrhage. A dark red lesion may be seen beneath the retina, and in many cases, there is an overlying elevation of the neurosensory retina.
OCT offers a high-resolution cross-sectional view, confirming where the blood is located (whether subretinal or sub-RPE) and checking for signs of retinal detachment or associated neovascular membranes.
Although blood can mask certain details, FA helps in identifying neovascularization by highlighting areas of active leakage. This is key for conditions like nAMD that often trigger subretinal hemorrhage.
Particularly useful if PCV is suspected, ICGA can offer further clarity when FA results are less definitive due to the presence of blood.
These diagnostic tests work together to provide a comprehensive picture of the hemorrhage, enabling our retina specialists to tailor the treatment approach to the specific characteristics of your condition. Accurate diagnosis is critical, as the therapeutic strategy heavily depends on the hemorrhage’s size, location, and underlying cause.
While the presence of a subretinal hemorrhage is concerning in itself, there are several complications that can develop if the condition is not promptly managed. Awareness of these potential risks helps underscore the importance of early intervention.
The accumulation of blood, especially if left untreated, may expose delicate photoreceptor cells to iron toxicity. This exposure can cause lasting damage that affects vision.
As blood accumulates, it may physically separate the retina from underlying layers, potentially leading to a detachment. This situation can further complicate treatment efforts.
The healing process sometimes results in scar tissue formation beneath the retina, which can create further disturbances in visual clarity.
Particularly common with conditions like nAMD, a disciform scar can form, leading to enduring central vision loss.
If the macula is involved, even small hemorrhages might have a major impact. Without rapid treatment, the central vision—essential for tasks such as reading, driving, and recognizing faces—may not fully recover.
These complications highlight why our retina specialists are vigilant in diagnosing and treating subretinal hemorrhage. The goal is always to limit damage and safeguard your vision through timely and appropriate management.
The treatment pathway for a subretinal hemorrhage depends on multiple factors: the size and location of the hemorrhage, the underlying cause, and the urgency indicated by the clinical exam. Our retina specialists carefully consider all these aspects to choose a suitable treatment strategy. Here are the main treatment modalities:
Often the first line of treatment, intravitreal injections using anti-vascular endothelial growth factor (anti-VEGF) medications such as ranibizumab, aflibercept, or bevacizumab help reduce neovascular activity. This treatment is especially useful in cases related to nAMD or PCV, working to prevent further bleeding by stabilizing newly formed blood vessels.
If you've experienced sudden changes in your vision, such as blind spots or distortions, it’s crucial to reach out to our experienced retina specialists, Dr. Smith and Dr. Johnson, at Specialty Vision. They are dedicated to providing personalized care tailored to your specific needs. Don’t wait—protect your vision today!
In cases of large submacular hemorrhages where the preservation of central vision is paramount, an injection of a small expansile gas (such as SF6 or C3F8) may be administered. Often, this gas is combined with tissue plasminogen activator (tPA) to help liquefy the clot, displacing it away from the fovea—the center of the macula.
For extensive hemorrhages, particularly those complicated by vitreous involvement or tractional forces, a pars plana vitrectomy (PPV) may be indicated. This minimally invasive surgery might be paired with a subretinal tPA injection and gas tamponade, aiming to restore the retinal position and minimize further damage.
Not every subretinal hemorrhage requires aggressive intervention. In cases where the bleeding is small, located peripherally, and associated with minimal visual symptoms, careful monitoring by our retina specialists may be advised. This approach allows for detailed observation before deciding if additional treatment is necessary.
Each of these therapies has its specific indications and limitations, and the chosen course of action is tailored uniquely to the individual's needs. With rapid treatment, many patients avoid the worst outcomes, emphasizing why prompt evaluation by our retina specialists is so crucial.
The outlook for someone with a subretinal hemorrhage depends largely on several factors. The location of the hemorrhage is key—if the macula is implicated, the risk for enduring central vision loss increases. Similarly, the overall size of the bleed and how quickly treatment is initiated are vital considerations.
Bleeds that involve the fovea or are extensive in size carry a poorer prognosis due to the direct impact on central vision and the complexity of the damage.
Early detection and timely treatment are the most critical aspects in limiting long-term damage. The longer the delay in addressing a subretinal hemorrhage, the higher the risk of permanent photoreceptor damage from both mechanical separation and iron toxicity.
The root cause, whether driven by neovascular conditions like nAMD or triggered by trauma, also plays a significant role. Certain underlying pathologies may predispose an eye to recurrent bleeding, requiring ongoing care and monitoring.
Thanks to advancements in both pharmacologic and surgical treatment options, the prognosis for many patients has improved significantly. However, these improvements rely on early recognition and intervention, which is why our retina specialists highly encourage you to seek evaluation if any warning signs of vision changes or unusual visual phenomena appear.
Your eye is experiencing bleeding beneath the light-sensitive retina. This can lead to loss of visual clarity, especially if the central area is involved, because the extra blood disrupts the normal function of your photoreceptors.
The severity largely depends on the location and extent of the bleeding. If you notice sudden changes in your central vision, such as a dark spot or distortion, it might indicate that the hemorrhage has affected the macula, and immediate evaluation is advised.
Preventive measures are closely linked to managing the underlying conditions. Regular eye examinations and effective control of diseases like nAMD or other retinal vascular disorders help reduce the risk of bleeding events. It’s all about early detection and routine check-ups.
Treatment ranges from intravitreal injections aimed at reducing abnormal blood vessel growth, to procedures such as pneumatic displacement or even surgical interventions if the hemorrhage is extensive. Your treatment plan is carefully determined by the specifics of your condition.
While many patients experience significant improvement with prompt and appropriate treatment, outcomes can vary. The best results are typically seen when the hemorrhage is detected and managed early, which is why immediate attention is critical if symptoms arise.
At our practice, we understand that learning you have a subretinal hemorrhage can be overwhelming. Our approach is always aimed at providing compassionate, patient-focused care while employing the latest diagnostic and treatment techniques. We incorporate detailed imaging studies, such as OCT and angiography, to fully understand the specific nuances of your hemorrhage.
Our team works meticulously to evaluate the extent of the bleed and devise a treatment plan that best suits your individual needs. With treatments ranging from intravitreal medications to advanced surgical procedures, we prioritize both the immediate stabilization of your vision and long-term eye health. Every step is explained in everyday language, because we believe that understanding your condition is the first step toward recovery.
Your treatment journey begins with a comprehensive evaluation during which our retina specialists assess the size, location, and cause of your subretinal hemorrhage. Here’s what you can typically expect:
You will undergo a thorough examination that may include advanced imaging techniques. These tests help pinpoint the position of the bleeding and guide the subsequent treatment decisions.
Following the diagnostic workup, our retina specialists will discuss the findings with you. This conversation will cover potential treatment strategies, whether that involves intravitreal injections to manage blood vessel growth or procedures designed to displace the hemorrhage.
Depending on the situation, treatment may be initiated promptly to prevent further damage, or a period of monitoring might be recommended if the hemorrhage is small and not centrally located.
Regular follow-up care is essential. These visits allow our retina specialists to track the healing process, adjust treatment if necessary, and ensure there’s no recurrence of bleeding.
Throughout this process, our goal is to provide reassurance and clear communication to help you understand every stage of your care.
Subretinal hemorrhage, especially when involving the macula, is a situation that demands prompt attention. The nature of the bleed and its potential to cause irreversible damage to photoreceptor cells make early intervention absolutely key. While some small, peripheral hemorrhages may be managed with careful observation, any sign of central vision loss calls for immediate evaluation.
Delays in treatment can allow complications such as scar formation and persistent central vision loss to take hold. That’s why our retina specialists are dedicated to not only educating you about this condition but also acting swiftly when risks are identified. The critical window for intervention means that if you notice any changes in your vision—even if they seem minor—reaching out to our office right away could make all the difference.
Subretinal hemorrhage is a serious condition that requires prompt evaluation and targeted treatment by our retina specialists. Early detection and immediate intervention are vital in preserving vision and reducing long-term complications. Contact our office immediately if you notice any changes in your vision.
If you've experienced sudden changes in your vision, such as blind spots or distortions, it’s crucial to reach out to our experienced retina specialists, Dr. Smith and Dr. Johnson, at Specialty Vision. They are dedicated to providing personalized care tailored to your specific needs. Don’t wait—protect your vision today!
Discover the causes, symptoms, and treatments for subretinal hemorrhage. Contact our retina specialists to safeguard your vision.
