Bleeding behind the eye is a symptom, not a single disease, making the question of whether it can be “cured” complex. This symptom covers several serious conditions, and the possibility of a full recovery depends entirely on the specific location of the bleeding and its underlying cause. While medical intervention can often clear the blood and restore vision, treatment goals focus on controlling the underlying condition, which may be chronic, rather than achieving a permanent cure.
Identifying the Source of Ocular Bleeding
Bleeding behind the eye, medically known as posterior segment hemorrhage, can originate from three main anatomical locations, each with distinct causes and prognoses.
Vitreous Hemorrhage
The most common form is a vitreous hemorrhage, which is bleeding into the vitreous cavity in the center of the eye. In adults, the most frequent cause is proliferative diabetic retinopathy, where abnormal, fragile new blood vessels grow on the retina and easily rupture. In younger individuals, eye trauma is the leading cause, though retinal tears or detachments can also break blood vessels as the vitreous gel pulls away from the retina.
Subretinal or Submacular Hemorrhage
A second serious type is subretinal or submacular hemorrhage, which occurs beneath the light-sensitive retina, often under the macula, the area responsible for central vision. The main cause is wet Age-related Macular Degeneration (AMD), where abnormal blood vessels grow from the choroid layer underneath the retina. These vessels are fragile and prone to leaking blood and fluid, which rapidly damages the adjacent photoreceptor cells. Another cause can be a ruptured retinal arterial macroaneurysm, a localized dilation of a retinal artery that bursts and leaks blood.
Retrobulbar Hemorrhage
The third type is a retrobulbar hemorrhage, which collects behind the eyeball within the bony socket called the orbit. This is typically caused by severe blunt trauma or can be a rare complication of certain eye or sinus surgeries. The danger is the rapid increase in pressure within the confined orbital space, which can compress the optic nerve and cut off its blood supply. This condition, known as orbital compartment syndrome, requires immediate intervention to prevent permanent vision loss.
Treatment Strategies Based on Cause
Treatment strategies for ocular bleeding are highly varied and directly correspond to the source of the hemorrhage and the severity of the underlying condition.
Observation and Medication
For a minor vitreous hemorrhage, especially one not caused by a retinal tear, the initial approach is often observation and watchful waiting. The body can slowly absorb the blood over weeks to months; patients may be advised to elevate the head of the bed to help the blood settle away from the visual axis. If bleeding is caused by abnormal vessel growth, such as in diabetic retinopathy or wet AMD, targeted treatments are necessary. Intravitreal injections of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) medications are common for wet AMD, blocking chemical signals that promote the growth and leakage of fragile vessels. Laser photocoagulation can also be used to treat the peripheral retina, reducing the stimulus for new blood vessel growth.
Surgical Intervention
Surgical intervention, most commonly a pars plana vitrectomy, is often required for dense hemorrhages that fail to clear after two to three months or when bleeding is associated with a retinal detachment. During this procedure, the surgeon removes the blood-filled vitreous gel and replaces it with a clear saline solution or a gas bubble. For submacular hemorrhage, vitrectomy is combined with an injection of a clot-dissolving agent, such as tissue plasminogen activator (tPA), to help displace the blood away from the macula.
Emergency Decompression
Retrobulbar hemorrhage requires the most urgent intervention due to the risk of optic nerve damage from pressure. In this emergency, a procedure called a lateral canthotomy and cantholysis is performed at the bedside to quickly decompress the orbit. This involves cutting the outer corner of the eyelids and the tendon supporting the lower lid, rapidly relieving pressure on the optic nerve. This decompression must be performed quickly, ideally within the first two hours of symptom onset, to prevent irreversible blindness.
Defining Recovery and Long-Term Outlook
The prognosis and definition of recovery are closely tied to the extent of damage the bleeding caused before treatment, particularly to the retina.
Vitreous Hemorrhage Recovery
For vitreous hemorrhage, visual acuity often improves significantly after the blood clears, whether spontaneously or through vitrectomy. However, the final vision is limited by the underlying disease. For example, vision may remain poor if the retina was already severely damaged by advanced diabetic retinopathy.
Submacular Hemorrhage Recovery
In cases of submacular hemorrhage, recovery depends on how quickly the blood is displaced from the macula, as blood is toxic to the photoreceptors. Patients who undergo surgical displacement often see a modest improvement in acuity within the first few months. However, the final result is constrained by the progression of the underlying macular pathology, necessitating ongoing anti-VEGF therapy to maintain gains.
Retrobulbar Hemorrhage Recovery
For patients with retrobulbar hemorrhage causing orbital compartment syndrome, the long-term outlook depends on the time elapsed before surgical decompression. A delay in treatment significantly increases the risk of permanent vision loss due to irreversible optic nerve ischemia. Regardless of initial treatment success, patients with chronic underlying diseases like diabetes or wet AMD require continuous monitoring and follow-up to prevent recurrence.