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 [1]. 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 [1]. They have a characteristic "flame shape" which is a result of the axons of the ganglion cells squeezing the blood horizontally within itself [1] [2].
• Deep intraretinal hemorrhages, also called "dot" and "blot", originate from the deep capillary layer and involve either the inner or outer nuclear layers [1] [2]. Dot and blot hemorrhages are easily visualized at the peripheral retina where the nerve fiber layer is thin [3]. 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 [3].
• Vitreous hemorrhages occur when blood from a pre-retinal or retinal hemorrhage escapes into the vitreous cavity [4] [5]. Patients with vitreous hemorrhages often report seeing "floaters", cloudy vision, "haze", and/or decreased light perception.

• Swelling

  Eighteen children (62%) had optic disk swelling. In 13 children, cerebrospinal fluid opening pressure was recorded (range, 27-59 cm H 2 O). CSVT risk factors included meningitis, mastoiditis, and hypercoagulability. [ncbi.nlm.nih.gov]

  Optic disc swelling was noted in 74 children. Sixteen subjects had splinter optic disc hemorrhages or superficial intraretinal hemorrhages, as well as moderate to severe optic disc swelling. [enews.sccm.me]

  VEGF can cause blood vessels to leak, causing swelling in the retina. This swelling is called macular edema. Medications that block VEGF can slow or stop the leakage. This often results in improved vision and a better prognosis for future vision. [retinasurgeonsanantonio.com]

  Foveal edema (swelling with fluid) is also present. Photo courtesy Anat Loewenstein, MD Figure 2. BRVO with macular edema. David Callanan, MD, Texas Retina Associates. BRVO/CHRPE. [asrs.org]

• Inflammation

  […] of the eyelids), dry eye, ocular hyperaemia (red eye), eye pruritis (itching), arthralgia (joint pain) and nasopharyngitis (inflammation of the nose and throat et Ma ei vasta Ellie nimele [et.glosbe.com]

  […] of the eyelids), dry eye, ocular hyperaemia (red eye), eye pruritis (itching), arthralgia (joint pain) and nasopharyngitis (inflammation of the nose and throat sv Jag såg honom vid sjukhuset [sv.glosbe.com]

  Membranes may also result from eye conditions or diseases such as diabetic retinopathy, retinal detachment, inflammation, injury or vascular conditions. [midhudsonretina.com]

  […] examination revealed numerous white-centered retinal hemorrhages bilaterally ( A, asterisks and B ), peripheral choroidal/deep retinal infiltrates ( A, black arrows and C ), and perifoveal chorioretinal infiltrates with overlying areas of focal vitreous inflammation [consultant360.com]

  They may occur with: An abnormal response to increased levels of the female hormone estrogen Chronic inflammation Clogged blood vessels in the cervix Cervical polyps are common. They are often found in women over age 40 who have had many children. [mountsinai.org]

• Surgical Procedure

  A vitrectomy is a surgical procedure that removes the vitreous gel and the blood from inside the eye. [maculacenter.com]

  Most macular holes can be successfully treated through vitrectomy, a surgical procedure to remove the vitreous gel and stop it from pulling on the retina. The doctor then inserts a mixture of air and gas into the area to keep its shape. [midhudsonretina.com]

  Clot dissolution took 15 to 60 minutes, which necessitated a break in the surgical procedure. 2 The liquefied clot was then removed during the subsequent air-fluid exchange. [retinalphysician.com]

  For the treatment of choroidal rupture, there are currently no medications or surgical procedures available that are particularly effective. [karger.com]

  Performing a minor surgical procedure known as anterior chamber paracentesis, in which numbing drops are used and a small amount of fluid is withdrawn from the front of the eye. [allaboutvision.com]

• Disability

  Please enable JS and disable any ad blocker [cairn.info]

  These include: age under 6 months, male sex, frequent crying, premature or low birth rate, or having special needs and disabilities. [webeye.ophth.uiowa.edu]

  Once you have taken this step of accepting this disability, do not hesitate in asking for help. You have to realize that you need to rely on something or someone in order to be independent again. [irisvision.com]

  Because of the wide variety of visual disability among RP patients, and because of the progressive nature of the disease, selection of the optimal low-vision aids is very patient-specific. [medicinenet.com]

• Rigor

  For instance, the hypothesis that bilberry anthocyanosides improve normal night vision in healthy subjects isn’t supported by evidence from rigorous clinical studies. 19 But a study of bilberry effects on retinal inflammation in endotoxin-induced uveitis [retinalphysician.com]

  Although previously approved and used in different countries worldwide, validation of true benefit has not been confirmed in rigorous, double-blind comparisons with sham intervention. [ahajournals.org]

• Vomiting

  About 1 hour later, the infant was crying, had vomitted and the mother felt he was lethargic. [pediatriceducation.org]

  Her seizures were simple tonic–clonic febrile seizures that lasted five minutes and were not accompanied by bouts of vomiting or resuscitation procedures. A detailed history and social inquiry raised no suspicion of child abuse. [adc.bmj.com]

  Coughing, sneezing, lifting heavy weights, and vomiting are common culprits. Have you ever had a floater appear all of a sudden, like a fly or black speck in your vision that just won't go away. [eyedolatryblog.com]

  […] haemorrhage stroke fibromuscular dysplasia non-accidental injury Statistics from Altmetric.com retinal haemorrhage stroke fibromuscular dysplasia non-accidental injury Case report An 11 month old male infant presented with a six hour history of irritability, vomiting [doi.org]

  Poor feeding, vomiting, apnea, irritability, seizures, decreased tone, and decreased consciousness are just a few of the ways that non-accidental trauma may present. [webeye.ophth.uiowa.edu]

• Nausea

  Excessive doses may cause nausea, vomiting, headache, blurred vision, dizziness, liver problems, and clumsiness. It may also increase a person's risk of developing osteoporosis. Vitamin A appears safe in pregnant women if taken at recommended doses. [columbiaeye.org]

  […] altitudes. [3] Independent risk factors for the development of high altitude illness are the altitude reached, individual susceptibility and rate of ascent. [4], [5] Climbers affected by AMS suffer from a variety of nonspecific symptoms such as headache, nausea [journals.plos.org]

  Upon questioning, the patient denied having symptoms of elevated blood pressure, including headache, dizziness, nausea, chest pain, paresthesias and shortness of breath. She reported that she did not take her hypertension medications that day. [journalofoptometry.org]

• Retinal Hemorrhage

  To correctly interpret a patient's retinal hemorrhages, the physician requires a broad knowledge base, including of child abuse, the "shaken baby/shaking-impact" syndrome, the differential diagnosis of retinal hemorrhages and the types of retinal hemorrhage [ncbi.nlm.nih.gov]

• Visual Impairment

  Methods: The authors describe a case report of a young male with a sudden severe bilateral visual impairment as a complication of aggressive lymphoma treatment. [evrs.eu]

  Thus, visual and neurologic outcomes are closely linked in non-accidental trauma. Up to 50% of children that survive non-accidental trauma will be left with some level of visual impairment. [webeye.ophth.uiowa.edu]

  impairment in the pediatric population. [retinatoday.com]

• Scotoma

  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]

• Confusion

  Immediately after the unresponsive episode, she was confused, had a headache, and lost vision in her left eye. No incontinence, weakness, or numbness occurred. Blood pressure and heart rate were not assessed. [ajnr.org]

  Submacular blood and exudation are often confused with age related macular degeneration (ARMD). 5 The bilateral nature of ARMD can help rule this out; however in patients who may additionally have ARMD, a fluorescein or indocyanine green angiogram can [journalofoptometry.org]

  Confusion Between Central Nervous System Infection and Shaken Baby Syndrome Fever, irritability, meningeal signs, elevated white counts and tense fontanelles suggest central nervous system infection. [westjem.com]

• Mydriasis

  Blindness / Vision loss / Visual impairment Anopsia Hemianopsia binasal bitemporal homonymous Quadrantanopia subjective Asthenopia Hemeralopia Photophobia Scintillating scotoma Pupil Anisocoria Argyll Robertson pupil Marcus Gunn pupil Adie syndrome Miosis Mydriasis [en.wikipedia.org]

  Anisocoria, poor pupillary reaction, and mydriasis often indicate severe concurrent central nervous system (CNS) depression. 5 Documentation of funduscopic findings by an ophthalmologist is critical in establishing a diagnosis in suspected cases of child [retinatoday.com]

  […] type 2 diabetes All patients registered with type 2 diabetes Jan 2005 – May 2008 Population based Scottish clinical database covers around 99% of diabetic population Screen programme (DRS) nation-wide since 2007 single-field digital photograph, with mydriasis [richtlijnendatabase.nl]

• Tremor

  […] periorbital puffiness; coarse skin; cold skin; slow movement; goiter High TSH; low or normal fT4 Hyperthyroidism Warm, moist skin; heat intolerance; nervousness; tremulousness; insomnia; weight loss; diarrhea; proximal muscle weakness Lid lag; fine tremor [ahajournals.org]

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].

The hemorrhage was not related to the type of the CNV lesion before treatment. [ncbi.nlm.nih.gov]

Alternative treatment Alternative treatment of retinal hemorrhages focuses on providing nutrients to strengthen and heal the injured blood vessels. [medical-dictionary.thefreedictionary.com]

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]

We review the literature regarding types of retinal hemorrhage and their associated etiologies. [ncbi.nlm.nih.gov]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

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]

[…] 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]

Current knowledge and trends in age-related macular degeneration: genetics, epidemiology, and prevention. Retina 2014;34(3):423-441. 2. Age-related Eye Disease Study Research Group. [retinalphysician.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]

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]

In this prospective high altitude study, we aimed to gain new insights into the pathophysiology of HAR and explored whether HAR could be a valid early indicator of altitude illness. [journals.plos.org]

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]

An optimal balance between acclimatization and subsequent altitude stress appeared to prevent retinal hemorrhage. [ncbi.nlm.nih.gov]

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]

How is vitreous haemorrhage prevented? Prevention of vitreous haemorrhage involves preventing the underlying causes. [patient.info]

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2. Levin AV. Retinal hemorrhage in abusive head trauma. Pediatrics. 2010;126:961-70.
3. 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.
4. 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.
5. Al Wadeai EA, Osman AA, Mackey TA, Soliman MM. Epidemiological features of pediatric ocular trauma in egypt. J Opthalmol. 2016; Epub 2016 Oct 5.
6. 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.
7. Billmire ME, Myers PA. Serious head injury in infants: accident or abuse? Pediatrics. 1985;75:340–2.
8. 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.
9. 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.
10. 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.