5 Things Lupus Sufferers Need to Know about Vitreous Hemorrhages

Vitreous hemorrhages are an ocular emergency that can affect people with lupus. They occur when blood leaks into your vitreous, the gel-like substance inside your eyeballs. Here are five things lupus sufferers need to know about vitreous hemorrhages.

How does lupus cause vitreous hemorrhages?

Lupus causes vitreous hemorrhages in the same way it causes other health complications throughout your body. As you may already know, when you have lupus, your immune system mistakenly attacks your healthy tissues. When it does this, autoantibody immune complexes are produced. These complexes are molecules that form when your immune cells bind to antigens. The complexes then deposit on your tissues.

If the autoantibody immune complexes accumulate within the blood vessels that supply your retina—the tissue in the very back of your eye that senses light—they will damage the vessels. This vessel damage can then cut off blood flow to your retina, which forces your body to create new blood vessels. This process is called neovascularization, and since these new vessels need to be made quickly, they're not very sturdy. Your new blood vessels can then bleed, resulting in vitreous hemorrhages.

Is this a common occurrence?

The risk of vitreous hemorrhage varies significantly based on how well controlled your lupus is. Only 3% of people with well-controlled lupus develop retinal involvement, compared to 29% of people with poorly controlled lupus. Of these people with retinal involvement, 40% may go on to later develop vitreous hemorrhages, according to Review of Ophthalmology. To keep yourself safe, remember to see your rheumatologist regularly for checkups and to take your lupus medications as directed. 

What are the signs of vitreous hemorrhages?

If the bleeding is minimal, you'll notice the appearance of a lot of new floaters. Your vision may also become hazy or blurred. In cases of more moderate bleeding, you'll see dark streaks across your vision that break up into small black dots. Severe vitreous hemorrhages will reduce your vision significantly and you may only be able to detect light; this means that you'll be able to tell if its day or night, but you won't be able to see much more than that.

In all of these cases, prompt medical attention is necessary, so if you notice any changes in your vision, see your optometrist right away.

What complications can vitreous hemorrhages cause?

The blood that drains into your vitreous has nowhere to go, so as the blood accumulates, the pressure inside your eye will increase. Increased pressure inside your eye leads to a condition known as glaucoma. Glaucoma is a very serious condition because the tissues inside your eyes are very delicate and can be damaged by the high pressure. If your optic nerve—the tissue that transmits the images you see to your brain—is damaged, you will experience vision loss or blindness.

Can vitreous hemorrhages be treated?

The bleeding needs to be stopped to prevent complications like glaucoma. In some cases, this can be accomplished nonsurgically. Your optometrist may inject dobesilate into your vitreous. Dobesilate is a vasoprotective medication that is used to treat problems like hemorrhoids or varicose veins, but it has been successfully used off-label to stop vitreous hemorrhages.

If this treatment doesn't work, you'll need to have a pars plana vitrectomy. This surgery is performed under general anesthesia and involves removing the vitreous from within your eye through a small incision. Once the vitreous has been removed, it will be replaced with a saline solution. This surgery has a high success rate and most people will experience a significant improvement in their vision.

If you have lupus and notice changes in your vision, you may be experiencing a vitreous hemorrhage and should see your optometrist immediately. You may also want to schedule and appointment with a rheumatologist at an establishment like Arthritis & Rheumatology Associates of South Jersey.