A 62-year-old man presents to the emergency department with sudden, painless loss of vision in his right eye. He describes seeing “dark floaters” and “cobwebs” that progressed over several hours. He denies eye pain, redness, or trauma. He has a long-standing history of type 2 diabetes mellitus. Visual acuity is markedly reduced in the right eye. Funduscopic examination of the right eye is limited due to poor visualization of the retina.
Which of the following is the most likely underlying mechanism responsible for this patient’s condition?
The correct answer is:
A) Bleeding from fragile neovascular vessels
Vitreous hemorrhage commonly presents with sudden, painless vision loss and complaints of floaters or “cobwebs.” In patients with long-standing diabetes, the most common cause is proliferative diabetic retinopathy, in which fragile neovascular vessels develop and are prone to rupture, leading to bleeding into the vitreous humor. Funduscopic examination is often limited due to obscuration of the retina by blood.
Answer choice B: Embolic occlusion of the central retinal artery, is incorrect. Central retinal artery occlusion causes sudden, profound vision loss with a pale retina and a cherry-red spot on funduscopic exam, not floaters or obscured visualization.
Answer choice C: Inflammatory infiltration of the uveal tract, is incorrect. Uveitis presents with eye pain, photophobia, and redness, often with inflammatory cells seen on slit-lamp examination rather than vitreous hemorrhage.
Answer choice D: Retinal detachment due to vitreous traction, is incorrect. Retinal detachment often presents with flashes of light and a curtain-like vision loss. Although vitreous traction can contribute to detachment, it does not explain vitreous hemorrhage in this context.
Answer choice E: Thrombosis of the central retinal vein, is incorrect. Central retinal vein occlusion presents with dilated tortuous veins and widespread retinal hemorrhages described as a “blood and thunder” appearance, not poor visualization due to vitreous blood.
Key Learning Point
Vitreous hemorrhage presents with sudden, painless vision loss and floaters, commonly caused by rupture of fragile neovascular vessels in proliferative diabetic retinopathy.
