The first approach for a subhyaloid hemorrhage is always conservative observation. Besides, bilateral hemorrhages in the vitreous, sub-hyaloid, or intra-retinal hemorrhages are also seen. Subhyaloid hemorrhage is seen typically in Terson syndrome and Valsalva retinopathy. Roth spots are generally asymptomatic and typically resolve with treatment of the underlying disease, especially subacute bacterial endocarditis. Hemorrhages seen in retinal vein occlusions are not treated per se, but the retinal edema or the neovascularization, which follows as a sequela, needs to be treated. Most dot and blot, splinter, and flame-shaped hemorrhages are not vision-threatening and are usually found in the posterior pole sparing the fovea and can be observed. Direct intervention for retinal hemorrhages is indicated in submacular, subhyaloid, and vitreous hemorrhages because of their potential to damage vision irreversibly. Hemorrhages that do not obscure or threaten vision do not warrant immediate treatment, and the primary systemic disorder causing the hemorrhages needs to be diagnosed and addressed. Characteristic clinical features include extensive bilateral multilayered retinal hemorrhages, intracranial injury (hemorrhage/hypoxic-ischemic injury), and occult fractures (ribs and long bone metaphysis).Ī solitary retinal hemorrhage can be observed and followed up for progression in size and number. This comes under abusive head trauma (AHT), is seen in young children caused by repeated acceleration-deceleration injury. Breakthrough hemorrhage into vitreous also happens in malignant choroidal melanoma, retinal vascular occlusions, and idiopathic polypoidal choroidal vasculopathy (IPCV). A subretinal hemorrhage can cause a breakthrough bleeding into the vitreous. They are commonly seen due to the rupture of a vessel, as seen commonly in proliferative diabetic retinopathy, retinal arteriolar microaneurysm, or during posterior vitreous detachment. Chronic hemorrhages appear as diffuse vitreous clouding with settled blood inferiorly. īleeding into the vitreous cavity is seen as fresh blood clots with sudden onset of floaters. Valsalva retinopathy is a pre-retinal hemorrhage caused by a sudden increase in intra-thoracic or intra-abdominal pressure. Hemorrhage may be present in the vitreous, subhyaloid, or intraretinal /sub-internal limiting membrane. Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury. Causes include Terson syndrome, Valsalva retinopathy, proliferative diabetic retinopathy, and proliferative retinopathy after retinal vein occlusions. Preretinal hemorrhages are “boat” or ‘D’ shaped hemorrhages which collect between the posterior limiting membrane of the vitreous and internal limiting membrane (ILM) of the retina. They are commonly seen in choroidal neovascular membranes (CNVM), choroidal tumors, and choroidal rupture secondary to acute trauma. These hemorrhages are located between RPE and Bruch membrane and appear dark red with well-defined sharp borders. Sub-macular hemorrhages are commonly seen in choroidal neovascular membranes secondary to ARMD. Such hemorrhages are commonly seen in ARMD, presumed ocular histoplasmosis, high myopia, PCV, retinal macroaneurysm, and trauma. The hemorrhages are deep red in color and broader in shape with diffuse margins. These hemorrhages occur between the photoreceptor layer and retinal pigment epithelium (RPE). Purtscher-like retinopathy is seen in acute pancreatitis, renal failure, and autoimmune disease. Retinal findings are intraretinal whitening, cotton wool spots, and intraretinal hemorrhages. Purtsher retinopathy is an occlusive microvasculopathy associated with cranial or thoracic compressive trauma. Common causes for such hemorrhages include diabetic retinopathy, retinal vein occlusions, ocular ischemic syndrome, sickle cell retinopathy, and juxta foveal telangiectasia. These are dense, dark red, sharply outlined, and are seen in disorders that affect the pre-venular deep capillary layer. These dot and blot hemorrhages are found within the inner nuclear and outer plexiform layers of the retina. Roth spots are characteristic of subacute bacterial endocarditis and also seen in leukemia, anemia, anoxia, and other rare conditions. Capillary rupture with extravasation, and central fibrin–platelet plug gives the white center to the Roth spot. It was Litten who described the association (Litten sign) and referred to it as Roth spots. Roth spots: Roth spots are round in shape with a white center.
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