Retinal hemorrhage refers to bleeding within the light-sensitive tissue on the posterior wall of the eye. A retinal hemorrhage may be caused by diseases (e.g., hypertension, retinal vein occlusion, diabetes), use of certain medications (e.g., anticoagulant therapy), or a head injury.
The presentation and appearance of a hemorrhage vary based on its location relative to the retina. Retinal hemorrhages are classified as subretinal, intraretinal (superficial and deep), pre-retinal, and vitreous.
Workup begins with a thorough review of the patient's medical history, current medication use, and history of present illness [6]. Any head injuries or trauma should be noted, particularly in young children and infants presenting with a retinal hemorrhage [7] [8]. Since the eyes are located near vital structures in the head and neck region, life-threatening injuries involving the intracranial region, the airway, and the cervical spine need to be considered prior to ocular assessment. In cases where head trauma is suspected or reported, a head computed tomography scan (CT) should be performed immediately [9] [10].
An ophthalmologic exam, using either an ophthalmoscope or fundus camera, is often sufficient to diagnose a retinal hemorrhage. An intravenous injection of a fluorescent dye prior to the ophthalmologic exam allows better visualization of the retinal blood vessels.
Laboratory studies may be done in patients with suspected comorbidities. For example, coagulation studies may be performed in patients with a coexisting intracerebral and retinal hemorrhage to rule out a bleeding disorder and blood cultures performed in patients suspected of having sepsis [10].
Imaging modalities such as a head and neck CT or magnetic resonance imaging (MRI) with contrast and/or angiography may be used to rule out an arteriovenous malformation, cavernous hemangioma, aneurysm, or fibromuscular dysplasia. A head CT should be done in any patient with a recent history of head trauma [10].