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.
- Subretinal hemorrhages refer to bleeding that is located between the neurosensory retina and retinal pigment epithelium (RPE). The source of bleeding is either the retinal or choroidal circulation . Subretinal hemorrhages appear as extensive dark-red regions, with the retinal vessels clearly visible above.
- Superficial intraretinal hemorrhages are a result of bleeding from the capillary bed located between the nerve fiber (NFL) and ganglion cell layers . They have a characteristic "flame shape" which is a result of the axons of the ganglion cells squeezing the blood horizontally within itself  .
- Deep intraretinal hemorrhages, also called "dot" and "blot", originate from the deep capillary layer and involve either the inner or outer nuclear layers  . Dot and blot hemorrhages are easily visualized at the peripheral retina where the nerve fiber layer is thin . They appear small and round because they occur in the deep longitudinally-oriented cell layers within the retina.
- Pre-retinal hemorrhages are located on the surface of the retina, posterior to the internal limiting membrane and anterior to the NFL. As these hemorrhages resolve, the blood cells settle inferiorly due to gravity resulting in a "boat-shaped" or "crescent" appearance .
- Vitreous hemorrhages occur when blood from a pre-retinal or retinal hemorrhage escapes into the vitreous cavity  . Patients with vitreous hemorrhages often report seeing "floaters", cloudy vision, "haze", and/or decreased light perception.
A 50-year-old man presented with blurry vision and scotomas in his right eye immediately after a 2-week hiking trip in the Andes at an altitude of 19,600 ft (6000 m). [nejm.org]
Convergence insufficiency Internuclear ophthalmoplegia One and a half syndrome Refraction Refractive error Hyperopia Myopia Astigmatism Anisometropia / Aniseikonia Presbyopia Vision disorders Blindness Amblyopia Leber's congenital amaurosis Diplopia Scotoma [en.wikipedia.org]
A peripheral ring scotoma (detectable by visual field testing) widens gradually, and central vision may also be affected in advanced cases. [msdmanuals.com]
More significant hemorrhage limits visual acuity and visual fields or can cause scotomas. Patients often say vision is worse in the morning as blood has settled to the back of the eye, covering the macula. [aao.org]
Photopsia is a common complain in patients with cone-rod RP in their mid-peripheral field of vision, adjacent to areas of scotoma. Photopsias may decrease over the years, as scotomas become denser. [institut-vision.org]
- Retinal Lesion
This case exemplifies the need for careful monitoring of renal function and retinal lesions not only in patients receiving IFN but also in those following the discontinuation of IFN treatment. [ncbi.nlm.nih.gov]
Retinal lesions as clues to disseminated bacterial and candidal infections: frequency, natural history, and etiology. Medicine (Baltimore). 2003;82(3):187-202. None of the authors have any proprietary interest in any aspect of this manuscript. [consultant360.com]
Clinical and microscopical features of retinal lesions. In: The retinal circulation. New York: Harper & Row, 1971:167–78. ↵ Goetting MG, Sowa B. Retinal haemorrhage after cardiopulmonary resuscitation in children: an etiologic reevaluation. [adc.bmj.com]
Retinal detachment due to peripheral tear in area of necrosis. Rate of progression of untreated retinitis is 250-350 µm per week. Skip lesions can occur. [emedicine.medscape.com]
- Marcus-Gunn Pupil
Anisocoria Argyll Robertson pupil Marcus Gunn pupil Adie syndrome Miosis Mydriasis Cycloplegia Parinaud's syndrome Other Nystagmus Childhood blindness Infections Trachoma Onchocerciasis This article about an ophthalmic disease is a stub. [en.wikipedia.org]
Workup begins with a thorough review of the patient's medical history, current medication use, and history of present illness . Any head injuries or trauma should be noted, particularly in young children and infants presenting with a retinal hemorrhage  . 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  .
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 .
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 .
This prognosis is due to several factors, including mechanical damage to the photoreceptors by fibrin infiltration. [retinalphysician.com]
What is the prognosis for retinitis pigmentosa? The prognosis varies widely among RP patients, with some retaining 20/40 or better vision in at least one eye and others eventually losing all useful central vision. [medicinenet.com]
Despite the potential pitfalls mentioned above, the study of Kumbhani et al. is still the largest series to date and offers important insights into the prognosis of this extremely high-risk group of subjects. [academic.oup.com]
Thus, the use of spironolactone has been associated with better prognosis in patients with heart failure,4 while it has been pointed out that treatment with doxazosin has been related with a higher incidence of heart failure, although it seems that this [revespcardiol.org]
A visual-evoked potential test three months later helps determine visual prognosis. Outcome The pediatric care team called in the Department of Child and Family Services. [consultqd.clevelandclinic.org]
The etiologies of retinal hemorrhage as well as the literature presently available to support or refute the various diagnoses are discussed. [ncbi.nlm.nih.gov]
Possible etiologies: Retinal neovascularization Posterior vitreous detachment & retinal breaks (result of tearing the major retinal vessels) Terson’s syndrome (vitreous heme + subarachnoid heme) Retinal trauma Valsalva retinopathy 2. [optometrystudents.com]
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
[…] evidence FREE Alexandre Persu, Eoin O'Brien and Paolo Verdecchia Hypertens Res advance online publication, April 17, 2014; doi:10.1038/hr.2014.83 Abstract | Full Text | PDF Top of page Featured Articles Resistant hypertension–its identification and epidemiology [nature.com]
Methods Statistics Trigonometry Medical & Nursing Anatomy Anesthesiology Audiology Bacteriology Biochemistry Bioethics Biomedical Science Cardiology Cardiovascular Childbirth Chiropractic Dentistry Dermatology Diagnostic Imaging Drugs Endocrinology Epidemiology [brainscape.com]
Diagnosis : Non-accidental trauma (commonly known as Shaken Baby Syndrome) EPIDEMIOLOGY Affects 1200-1400 infants every year. 30% mortality rate. Up to 50% of survivors left with visual impairment. Usually occurs in infants under 6 months of age. [webeye.ophth.uiowa.edu]
When exudation dominates the clinical picture additional conditions to consider include Coat's disease, Leber's milliary aneurysms and angiomatosis retinae. 2 While similar in appearance, the epidemiology of these conditions differ. [journalofoptometry.org]
In this review, we present an update about this entity, with focus on its pathophysiology and practical implications. [ncbi.nlm.nih.gov]
[…] recognition of this association, multiple streams of research, including clinical, postmortem, animal, mechanical, and finite element studies, have created a robust understanding of the clinical features, diagnostic importance, differential diagnosis, and pathophysiology [pediatrics.aappublications.org]
Understanding the pathophysiology of the retinal vascular system helps in the diagnosis of this and many other ocular diseases, leading to appropriate management. [optometricmanagement.com]
Prevention The first step in sound prevention is for people with vision problems, including visual spots, flashes or floaters in the vision, and loss or distortion of visual accuracy, to see an opthalmologist as soon as possible. [medical-dictionary.thefreedictionary.com]
During the 2 weeks, he was taking acetazolamide in an effort to prevent altitude sickness and reported having no symptoms during his hike. On examination, his visual acuity was 20/50 in the right eye and 20/20 in the left eye. [nejm.org]
An optimal balance between acclimatization and subsequent altitude stress appeared to prevent retinal hemorrhage. [ncbi.nlm.nih.gov]
الصفحة 234 - Centers for Disease Control and Prevention: 1994 Revised Classification System for Human Immunodeficiency Virus Infection in Children Less Than 13 Years of Age, MMWR, 43, 1-19, No. [books.google.com]
- Aryan HE, Ghosheh FR, Jandial R, Levy ML. Retinal hemorrhage and pediatric brain injury: Etiology and review of the literature. J Clin Neurosci. 2005;12:624-31.
- Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126:961-70.
- Retina. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.274.
- Vitreous hemorrhage. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.296.
- Al Wadeai EA, Osman AA, Mackey TA, Soliman MM. Epidemiological features of pediatric ocular trauma in egypt. J Opthalmol. 2016; Epub 2016 Oct 5.
- Lima VC, Cavalieri GC, Lima MC, Nazario NO, Lima GC. Risk factors for diabetic retinopathy: a case-control study. Int J Retina Vitreous. 2016; 2:21.
- Billmire ME, Myers PA. Serious head injury in infants: accident or abuse? Pediatrics. 1985;75:340–2.
- Gilliland MG, Luckenbach MW, Chenier TC. Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse. Forensic Sci Int. 1994; 68:117.
- Karibe H, Kameyama M, Hayashi T, Narisawa A, Tominaga T. Acute Subdural Hematoma in Infants with Abusive Head Trauma: A Literature Review. Neurol Med Chir (Tokyo). 2016;56:264-73.
- Trauma. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th ed, Ehlers JP, Shah CP (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.12.