Ophthalmology
Question 25 of 97
A 49 year old woman presents to the Emergency Department complaining of sudden onset floaters and dark streaks in her vision. She has a past medical history of insulin dependant diabetes. On slit lamp examination you are able to see red blood cells in the anterior chamber. What is the most likely diagnosis?
Answer:
Clinical features of vitreous haemorrhage:- Early/mild haemorrhage
- New floaters
- Moderate haemorrhage
- Dark streaks
- Dense haemorrhage
- Fall in visual acuity
Vitreous Haemorrhage
Ophthalmology
Last Updated: 12th February 2021
Vitreous haemorrhage is the extravasation of blood into one of the several potential spaces formed within and around the vitreous body.
Causes
- Abnormal vessels
- Diabetic retinopathy
- Neovascularisation from branch or central retinal vein occlusion
- Sickle cell retinopathy
- Rupture of normal vessels
- Retinal tear or detachment
- Posterior vitreous detachment
- Trauma
- Blood from adjacent source
- Macroaneurysm
- Age-related macular degeneration
Clinical features
- Early/mild haemorrhage
- New floaters
- Moderate haemorrhage
- Dark streaks
- Dense haemorrhage
- Fall in visual acuity
Management
- Urgent referral to ophthalmology
- Treatment is directed at the underlying cause
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
