Does Aspirin Make Bleeding in Diabetic Retinopathy Worse?
Aspirin and Diabetic Eye Bleeding at a Glance
Some eye changes cannot wait. Call your eye doctor the same day if any of these start.
- Sudden vision loss in one eye or in both eyes
- A dark curtain or shadow moving across your sight
- A sudden shower of new floaters, which look like specks or cobwebs
- Flashing lights that are new for you
- Severe eye pain with a red eye
Several of these signs point to bleeding inside the eye. In diabetic retinopathy, blood vessels in the retina can start to bleed into the vitreous, the gel-like fluid that fills your eye, and you may see dark floating spots or streaks that look like cobwebs; the spots sometimes clear up on their own, but it is important to get treatment right away1. Getting seen early is what keeps the most options open. Do not stop your aspirin on your own while you wait to be seen. That choice belongs with the doctor who put you on it.
The best evidence says no. In a randomized trial of 3,711 people with diabetic retinopathy, bleeding into the vitreous or in front of the retina happened in about 30 of every 100 people on a placebo and about 32 of every 100 on aspirin, a difference that was not statistically meaningful, and the bleeds were no more severe and cleared no more slowly2. A national diabetes guideline puts it plainly: retinopathy alone should not stop aspirin taken to protect the heart3.
The worry is reasonable on its face. Aspirin makes blood slower to clot, diabetic retinopathy bleeds, and it seems obvious that the two should add up. They do not, at least not in the eye. The bleeding in diabetic retinopathy comes from fragile new blood vessels in a damaged retina1. One way to picture it: that is closer to a plumbing problem than a clotting problem, and thinning the blood a little does not appear to change how often those vessels give way.
What Aspirin Does in the Body and in the Eye
Aspirin is an old medicine with a narrow modern job. It works by blocking natural substances in the body that cause fever, pain, swelling, and blood clots, and it is used to lower the risk of heart attack and stroke as well as to treat pain and fever4. The heart-protection version is the small daily tablet, often called low-dose aspirin. Warfarin and apixaban are a different class of medicine with different risks, and this page is about aspirin.
Many people with diabetes end up on a daily tablet to lower the risk of heart attack and stroke4. Some take it because they have already had a heart attack, a stent, or a stroke, which is called secondary prevention. Others take it as a precaution before anything has happened, which is called primary prevention. That distinction matters later on this page, because the two groups have very different amounts to lose if the aspirin stops.
The bleeding comes from the disease, not from your medicine cabinet. Diabetic retinopathy damages the small blood vessels of the retina, and in its later stages it can lead to bleeding inside the eye and to vision loss1. Years of high blood sugar leave parts of the retina short of oxygen, and the retina answers by growing fragile new vessels. Those vessels sit where the gel inside the eye can tug on them, and when one tears, blood spills into the space you see through.
What the Research Shows About Aspirin and Eye Bleeding
One large trial settled the core question decades ago. The Early Treatment Diabetic Retinopathy Study randomly assigned 3,711 people with diabetic retinopathy to aspirin or a placebo and found no rise in vitreous or preretinal bleeding, with about 30 of every 100 placebo takers and about 32 of every 100 aspirin takers having such a bleed over follow-up2. The severity of those bleeds and how fast they cleared were also no different. Randomizing people is what makes this convincing: nothing but chance decided who took aspirin.
A recent trial checked the same ground with today's smaller daily tablet. In a randomized placebo-controlled study of 15,480 adults with diabetes followed a mean of 6.5 years, referable retinopathy or maculopathy showed up in about 15 of every 100 people in each group, and sight-threatening eye bleeds were not more common among those taking aspirin5. So aspirin did not help the retina and did not harm it. That is a useful pair of findings, because it removes both the hope and the fear.
The two trials used different aspirin amounts, different eras of care, and different measures, and they landed in the same place.
| Trial | Who took part | Eye bleeding result |
|---|---|---|
| ETDRS, 1995 | 3,711 with retinopathy | No rise with aspirin |
| ASCEND-Eye, 2024 | 15,480 with diabetes | No rise with aspirin |
Two honest caveats belong here. An older randomized trial of 475 people with early retinopathy reported a smaller yearly rise in microaneurysm counts, a laboratory-style measure of tiny vessel bulges, among those given aspirin6, which some people misread as aspirin treating retinopathy. It does not: the modern trial found no reduction in referable retinopathy or maculopathy5. The second gap is that this research studied people on aspirin alone, so it says less about someone taking aspirin plus a second blood-thinning medicine.
How Aspirin Is Taken and Why the Reason Matters
Daily aspirin for the heart is one small tablet by mouth. For heart attack and stroke prevention it is taken once a day4. Your prescriber sets the strength and the schedule, so follow your own bottle rather than any general description. It comes in more than one form, so check with your pharmacist before switching brands or forms. If you also take painkillers, check whether any of them are aspirin under another name.
Ask your prescriber which camp you are in, because it changes this conversation. If you take aspirin after a heart attack, a stent, or a stroke, the bar for stopping is high. If you take it as a general precaution without any of those events, the balance is closer, and that is worth revisiting with your prescriber. Either way, the eye is not the deciding factor.
Stopping is not a neutral act. In a study following 601,527 long-term aspirin users, those who stopped had more heart attacks, strokes, and cardiovascular deaths than those who continued, which the authors described as roughly one extra event each year for every 74 people who stopped7. That was an observational study rather than a randomized one, so it shows an association rather than proof of cause. It is still enough to make quietly stopping the wrong move.
Side Effects of Aspirin, and Which Ones Need a Call
Aspirin does carry a genuine bleeding risk, just not the one people ask about. The Drug Facts label warns that aspirin may cause severe stomach bleeding, and lists higher risk for people aged 60 or older, people with a history of stomach ulcers or bleeding problems, people also taking a blood thinner, a steroid drug, or another anti-inflammatory painkiller, and people having three or more alcoholic drinks a day8. If you recognize yourself on that list, that is a conversation to have, and there are ways to lower the risk.
These signs mean stop and get advice, not wait and see.
- Black or tarry stools, or visible blood in the stool
- Vomiting blood, or vomit that looks like coffee grounds
- Feeling faint or unusually weak
- Stomach pain that does not get better
The label tells you to stop taking it and ask a doctor if any of those appear8. None of that is a reason to fear the tablet. It is a reason to know the signs, because acting on them early is what keeps a bleed small.
Some effects are visible rather than dangerous. Aspirin works by blocking natural substances in the body that cause blood clots4, which is why bruising and small bleeds such as a nosebleed can be more noticeable while you take it. A bright red patch on the white of the eye can also appear. That patch sits on the surface, not inside the eye where retinopathy bleeds, and your eye doctor can tell the two apart in seconds. Mention any of these at your next visit, and sooner if they keep coming back.
Who Should Be Careful With Aspirin
Daily aspirin is not a self-serve decision. The label directs people to ask a doctor or pharmacist before use if they are taking a prescription drug for diabetes, gout, or arthritis, if they are taking any other drug, or if they are under a doctor's care for any serious condition8. Anyone with a bleeding disorder, an active ulcer, a true aspirin allergy, or asthma that flares with painkillers needs individual advice. Pregnancy has its own rules and its own reasons for aspirin, so that is a discussion with your obstetric team.
Aspirin is a different matter entirely in young people. The label warns that children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use it, because of the risk of Reye's syndrome, a rare but serious illness8. If a young person in your family has diabetes and eye disease, aspirin is not part of the plan unless a specialist has specifically prescribed it.
The risk climbs when medicines stack. Taking aspirin together with a blood thinner, a steroid tablet, or another anti-inflammatory painkiller raises the chance of stomach bleeding8. Regular alcohol adds to it. Many over-the-counter cold and pain products contain an anti-inflammatory drug without saying so on the front of the box, so read the ingredient panel. Bring your full list to your next appointment and ask whether the stack still makes sense.
Aspirin Around Eye Injections, Laser, and Surgery
These are the procedures most people with diabetic retinopathy actually face, and they are the least worrying. They are done in a clinic room with numbing drops rather than in an operating room. Tell the team you take aspirin, and let them tell you what, if anything, to do about it. Do not pause your aspirin before an injection or an office laser unless the person who prescribed the aspirin tells you to, because that is the doctor holding the other half of the risk.
Operating-room procedures involve deeper needles, so the question is fairer here. A review of five studies covering 24,332 patients found mild to moderate bleeding during needle-based eye anesthesia in about 6 of every 100 aspirin users and about 4 of every 100 non-users, a difference that was not statistically significant, with severe bleeding in roughly 4 of every 10,000 patients and no significant difference between groups9. The same authors noted the data are not strong enough to settle the question fully.
The decision is your surgeon's and your prescriber's together, not yours alone and not your eye doctor's alone. They weigh why you take aspirin, what operation you need, and what else you take. Because the evidence on eye procedures is not strong enough to set one rule9, practice varies between surgeons. Ask at your pre-operative visit rather than the night before, so there is time to check with the doctor who prescribed it.
When to Call, and How Often to Get Your Eyes Checked
Regular exams matter more than anything on this page. People with diabetes need a comprehensive dilated eye exam at least once a year, and sometimes as often as every 2 to 4 months once retinopathy is present1. Guidelines advise that exam when type 2 diabetes is diagnosed, then at least once a year whenever any level of retinopathy is present10. If one or more yearly exams show no retinopathy and your glucose numbers are in your goal range, those same guidelines say every 1 to 2 years may be considered instead10. They also pair those exams with work on blood glucose, blood pressure, and blood lipids10. Early retinopathy usually causes no symptoms1, so your own vision is not a reliable alarm. Your eye doctor sets your own interval, so follow the date they give you.
Between the same-day list at the top and your yearly exam sits a middle zone. Call for an appointment within a week or so if you notice blurring that does not clear, new trouble reading, a small blank spot in your central vision, colors looking washed out, or a few new floaters that are not a sudden shower. None of these means disaster. They mean your retina deserves a look sooner than your next scheduled slot.
Match the question to the clinician. Vision changes go to your eye doctor, an optometrist or ophthalmologist, and sudden ones go there the same day. Whether to keep taking aspirin goes to whoever prescribed it, usually a primary care clinician or cardiologist. Questions that straddle both, such as whether an upcoming eye operation should change your aspirin, deserve both. Ask each of them to send a note to the other.
Common Questions About Aspirin and Diabetic Eye Bleeding
Not on your own. Call the doctor who prescribed the aspirin and your eye doctor, and let them decide together. The trial evidence says aspirin did not raise the rate of these bleeds or make them worse2, so the bleed is most likely the retinopathy rather than the tablet. Meanwhile, stopping carries its own risk of heart attack and stroke7. Get the bleed evaluated quickly, because that is the part that is genuinely time-sensitive.
The trial that looked specifically at this found no difference. In that study the severity of vitreous and preretinal bleeds and the speed at which they cleared were both similar between the aspirin and placebo groups2. How fast your own bleed clears depends much more on its size, where it sits, and whether the vessels that caused it are still active. Your retina specialist can give you a realistic timeline once they have looked.
No. Retinopathy comes from years of damage to the small blood vessels of the retina, not from aspirin1, and blood glucose, blood pressure, and blood lipids are the levers guidelines point to10. The modern randomized trial found the same rate of referable retinopathy and maculopathy whether people took aspirin or a placebo5. These are the things your diabetes team already talks to you about.
That combination is a different question, and this page cannot answer it for you. The eye research mostly studied people on aspirin alone, so it says less about stacked medicines. What is clear is that combining them raises overall bleeding risk, which is why the label warns about it8. If you are on both, ask the prescriber whether you still need both. That is a periodic review worth requesting rather than assuming it has been done.
There is no eye-based reason to. The trial that showed no rise in eye bleeding used a much larger daily amount than today's small tablet2, and the modern trial using the small tablet found the same reassuring result5. Your strength is set by your heart risk and your stomach risk, not your retina. If your stomach is the concern, that is a real reason to revisit the strength, and it is worth raising directly.
Neither, until they have actually spoken. Ask your eye doctor to write down exactly what worries them and ask your prescriber to respond to that specific concern. Most apparent disagreements dissolve once each sees the other's reasoning. If a real conflict remains, the doctor carrying the larger risk usually leads, and for most people on aspirin after a cardiac event, that is the prescriber.
More Questions People Bring to Their Retina Specialist
There is no evidence that it does. The modern trial found the same rate of referable retinopathy and maculopathy in both groups, which is the measure closest to needing treatment5. What drives whether you need injections or laser is how far the retinopathy has progressed and whether the center of the retina is swollen1. Aspirin is not part of that calculation, and it will not be the reason your treatment plan changes.
Swapping is not the safe move you might expect. Those medicines belong to the same anti-inflammatory family, and taking one alongside aspirin raises the chance of stomach bleeding8. Whether anything can replace the job your aspirin is doing is a question for your prescriber. Ask them or your pharmacist what to use for everyday pain, because the answer depends on your kidneys, your stomach, and everything else you take.
There is no single answer, and that is the honest response rather than a dodge. Practice varies between surgeons and between operations, and the evidence on eye procedures is not strong enough to settle it9. Ask at your pre-operative visit, not the night before. The surgeon needs time to contact whoever prescribed the aspirin, and that conversation is what produces a safe plan for you specifically.
The modern evidence says no. The large randomized trial found no reduction in referable retinopathy or maculopathy among people taking aspirin5. An older trial did report slower growth in microaneurysm counts6, but that is a laboratory-style measure that never translated into better vision. Take aspirin for your heart if your prescriber recommends it, and look after your eyes through blood sugar control and regular exams instead.
- Am I taking aspirin after a cardiac event, or as a general precaution?
- Given my stomach and my age, is daily aspirin still the right call for me?
- What stage is my diabetic retinopathy, and how fast has it changed?
- If I need eye surgery, who decides about pausing my aspirin, and when?
- Which symptoms should make me call you the same day?
- Can my eye doctor and my prescriber send each other notes?
- National Eye Institute (NEI), National Institutes of Health (2024). Diabetic Retinopathy.
- Archives of Ophthalmology, 113(1):52-55 (PMID 7826294) (1995). Effects of aspirin on vitreous/preretinal hemorrhage in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report no. 20.
- Diabetes Care 40(3):412-418 (Solomon SD et al.) (2017). Diabetic Retinopathy: A Position Statement by the American Diabetes Association.
- MedlinePlus, US National Library of Medicine (2024). Aspirin: MedlinePlus Drug Information.
- Ophthalmology (Sammons EL et al.), a sub-study of the ASCEND randomised trial (2024). ASCEND-Eye: Effects of Aspirin on Diabetic Retinopathy.
- Diabetes 38(4):491-498 (PMID 2647556) (1989). Effect of aspirin alone and aspirin plus dipyridamole in early diabetic retinopathy. A multicenter randomized controlled clinical trial. The DAMAD Study Group.
- Circulation 136(13):1183-1192 (Sundstrom J et al.) (2017). Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.
- DailyMed, US National Library of Medicine (FDA-required OTC label) (2024). ASPIRIN 81 MG tablet, coated: over-the-counter Drug Facts label (Warnings, Stomach bleeding warning, Stop use and ask a doctor if).
- PLOS One 11(1):e0147227 (Takaschima A et al.) (2016). Risk of Hemorrhage during Needle-Based Ophthalmic Regional Anesthesia in Patients Taking Antithrombotics: A Systematic Review.
- American Diabetes Association, Diabetes Care volume 49, page S261 (2026). 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes 2026.