Vitreous hemorrhage (VH) is a common but alarming condition where blood leaks into the vitreous cavity, often causing a sudden and painless loss of vision.
While it affects approximately 7 in every 100,000 people annually, the most frequent cause in patients without diabetes is posterior vitreous detachment (PVD).
Managing this condition remains a challenge for clinicians because the “natural course”—or how the eye heals on its own—has historically been poorly understood due to a lack of large-scale studies and clear clinical guidelines.
A recent study published in Ophthalmology by researchers at Copenhagen University Hospital, Rigshospitalet, provides much-needed clarity on what patients and doctors can expect. By reviewing the medical records of 366 patients over a five-year period, the study team tracked the progression of VH from initial presentation through at least two years of follow-up.
Will the Vision Clear on Its Own?
The study found that the majority of patients—62%—experienced spontaneous clearance of the hemorrhage without the need for surgery. However, the speed of this recovery is heavily influenced by the initial density of the blood.
The researchers categorized the severity of the hemorrhage into three grades:
• Grade 1 (Partial Clear): Most of the optic disk and superior vessels are visible.
• Grade 2 (Hazy): Only parts of the upper retina are barely visible.
• Grade 3 (No View): The hemorrhage is too dense to see the retina at all.
While many clearances happened within the first 60 days, those with Grade 2 or 3 hemorrhages faced a much longer road to recovery. After the 60-day mark, the likelihood of spontaneous resolution dropped significantly, with only 48% of remaining cases clearing on their own.
The Critical Three-Week Window
The most significant concern with VH caused by PVD is the risk of a rhegmatogenous retinal detachment (RRD). The study revealed that 17% of patients developed a retinal detachment during the observation period.
Crucially, the timing of these detachments followed a specific pattern. The median time to RRD was just 15 days, with the vast majority occurring within the first three weeks of presentation. This suggests that the early phase of observation is the most dangerous, requiring vigilant and frequent monitoring.
When is Surgery the Better Option?
While conservative management (rest and observation) works for many, the study suggests an individualized management strategy. Because prolonged hemorrhage can lead to work incapacity and rare complications like ghost cell glaucoma, early vitrectomy (surgical removal of the vitreous) should be considered for high-risk individuals.
Specifically, the authors suggest that younger, pseudophakic men with dense Grade 2 or 3 hemorrhages may benefit from early surgery to prevent RRD and accelerate visual recovery. In contrast, mild Grade 1 cases are generally best managed with observation.
Monitoring a vitreous hemorrhage is like navigating a ship through a heavy morning mist; while you can generally trust the sun to eventually burn the fog away, you must keep a sharp eye on the sonar during the first hour of the journey, as that is when you are most likely to strike a hidden reef.
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Reference : Hasbolat H, Christensen UC, Lund-Andersen C. Vitreous Hemorrhage due to Posterior Vitreous Detachment: Incidence of Retinal Detachment and Spontaneous Clearance during observation. Ophthalmology. 2026. doi:10.1016/j.ophtha.2025.11.014.
