Barry 19 presents with acute painless unilateral loss of vision, which was preceded by seeing floaters and flashes, cobwebs and a red haze. He has a history of hypertension and type 2 diabetes. Fundoscopy looks as below.

What are the most likely differential diagnosis for this presentation?

1. Vitreous Haemorhage
2. Retinal detachment
3. Posterior Vitreous detachment

What is the most likely diagnosis?

1. Vitreous Haemorhage
2. What are the key features of history in this condition?
3. Suggested Answer Key
4. Sudden, painless visual loss or haze.
5. Sudden onset floaters or blobs
6. Variable visual acuity, depending on the size of the haemorrhage. It may be dramatically reduced.
7. Changes over less than 1 hour
8. A red hue.
9. New-onset floaters and ‘cobwebs’.
10. Symptoms which may be worse in the morning if blood settles on the macula during sleep.

What past medical history would you most want to inquire about?

1. diabetes,
2. hypertension,
3. sickle cell disease,
4. ocular surgery or
5. trauma

What are the most important differentials of flashers and floaters?

1. Vitreous detachment
2. Retinal detachment
3. Vitreous haemorrhage
4. Normal ageing
5. Choroiditis- posterior uveitis

What are the most common causes of this presentation?

1. Proliferative diabetic retinopathy
2. Posterior vitreous detachment
3. Open globe injury
4. Closed globe injury from blunt trauma.
5. Shaking injuries

What are the key features of examination in this condition?

1. Reduced red light reflex secondary to blood clots
2. VA variable
3. Direct pupil response normal
4. Blood in the vitreous
5. Retina may not be seen and need to exclude retinal detachment and see if that’s the cause

What is the most important initial management step?

1. Referral to Ophthalmologist

What are the potential complications of this disease?

1. Haemosiderosis bulbi
2. Proliferative vitreoretinopathy.
3. Ghost cell glaucoma
4. Haemolytic glaucoma

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