Vitreous Hemorrhage in a diabetic

[Richard_Hom]

A 38-year old male presents from the Emergency Department complaining of blurred vision of 3 days onset. The blurred vision occurred over a period of 6-12 hours and did not change in character or severity since that first day. He reports that the blurry vision occurred immediately after lifting a heavy pipe from the ground while working at his occupation as a plumber.

His significant ophthalmic history includes focal argon laser treatment of the left eye for clinically significant macular edema just 8 days prior to the ED visit. The focal laser procedure included 56 applications with 0.5 second duration , 200 MW screen voltage, with 100 mciron spot size.

His relevant medical history consists of a "new" diagnosis of Type 2 diabetes with a diagnostic HgbA1c of 12.6 managed with Glyburide 5mg 1 by mouth 2 times a day and Metformin 500mg 2 by mouth two times a day; hypertension managed by Lisinopril 20mg 2 by mouth once a day and enteric - coated aspirin 81 mg 1 by mouth daily.

Fundus examination revealed CF at 3ft without improvement with pinhole. There was a red reflex present. Patient demonstrated directionalization using the lamp of the indirect ophthalmoscope. IOP's were 17mm Hg in each eye. Anterior segment examination was entirely normal.

Questions

1. Can heavy exertion precipitate a vitreous hemorrhage in a predisposed diabetic?
2. Is the vitreous hemorrhage coincidental with the focal laser treatment or could it have been related with heavy physical exertion?
3. What is the usual course of onset of a large vitreous hemorrhage?
   

Thanks so much,
Richard Hom, OD
San Mateo CA

---

Members don't see this ad.

 

[Visioncam]

I once saw a man in the ER who had diminished vision after lifting furniture (not just one piece but moving an entire household). He had a VH.

 

[Andrew_Doan]

Questions

1. Can heavy exertion precipitate a vitreous hemorrhage in a predisposed diabetic?
2. Is the vitreous hemorrhage coincidental with the focal laser treatment or could it have been related with heavy physical exertion?
3. What is the usual course of onset of a large vitreous hemorrhage?

Heavy exertion can precipitate VH in a predisposed diabetic:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3231911

Retina. 1988;8(3):174-6. Related Articles, Links


Vitreous hemorrhage and the Valsalva maneuver in proliferative diabetic retinopathy.

Kassoff A, Catalano RA, Mehu M.

Department of Ophthalmology, Albany Medical Center Hospital, New York.

A 59-year-old man with bilateral proliferative diabetic retinopathy underwent fluorescein angiography as a baseline study. Soon after intravenous injection of fluorescein, the patient had an extended episode of vomiting resulting in bilateral vitreous hemorrhages. Photographic evidence is presented that confirms the clinical impression that vitreous hemorrhage may be precipitated by a Valsalva maneuver.

I haven't heard of focal laser causing VH and doubt this was the cause.

The patient should be evaluated for NVE/NVD b/c this may be the cause of the new VH.

VH can progress quickly in a few hours to days.

 

[2020]

I have seen a case after heavy exertion. We can start a case series! Call it the Student Doctor Vitreous Hemorrhage Study Group.