Intraocular Hemorrhage

Excerpt

Intraocular hemorrhage is a critical condition characterized by bleeding within the eye, which can occur in any vascularized structure. Bleeding can affect various areas, including the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, and optic disc. The condition can arise from trauma, systemic vascular diseases such as diabetes and hypertension, retinal vein occlusion, neovascularization, or, in rare cases, spontaneously. Intraocular hemorrhage is typically classified based on the specific location and extent of the hemorrhage.

Hyphema

Hyphema refers to bleeding from the iris, ciliary body, trabecular meshwork, and associated vasculature into the anterior chamber, which is bordered by the cornea anteriorly, the iridocorneal angles laterally, and the lens posteriorly. Microhyphema denotes a minimal amount of blood in the anterior chamber, detectable only through microscopic examination.

Vitreous Hemorrhage

Vitreous hemorrhage refers to bleeding within the anterior chamber of the eye. This condition can be further classified based on the specific location and characteristics of the bleeding.

1. Intragel hemorrhage: This refers to the accumulation of blood within the vitreous body, bordered anteriorly by the anterior hyaloid membrane, laterally by the nonpigmented ciliary epithelium, and posteriorly by the posterior hyaloid membrane. The blood settles inferiorly and clots easily. As the red blood cells degenerate, the color of the vitreous hemorrhage transitions from bright red to yellow.

1. Preretinal hemorrhage: This can be subdivided into 2 categories, as mentioned below.

   1. Subhyaloid hemorrhage: This type of bleeding occurs between the internal limiting membrane (ILM) and the posterior subhyaloid membrane, often presenting in a boat-shaped configuration. If the posterior hyaloid membrane remains intact, the hemorrhage is immobile. However, if the posterior hyaloid is detached, the blood may shift with eye movement. Subhyaloid hemorrhages are commonly observed in proliferative diabetic retinopathy.

   2. Sub-ILM hemorrhage: In this type, bleeding occurs between the ILM and the nerve fiber layer of the retina, also exhibiting a boat-shaped configuration with a horizontal upper border. The affected area remains immobile. Sub-ILM hemorrhage is frequently associated with conditions such as Valsalva retinopathy, Terson syndrome, and retinal microaneurysms.

1. Hemorrhage in the Berger space, Cloquet canal, or canal of Petit is also classified as vitreous hemorrhage.

Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage occurs when long or short ciliary arteries rupture, causing bleeding into the suprachoroidal space between the choroid and sclera. This type of bleeding typically occurs intraoperatively or postoperatively, following trauma, and, very rarely, spontaneously. Intraoperative hemorrhage is referred to as expulsive suprachoroidal hemorrhage, while postoperative hemorrhage is known as delayed suprachoroidal hemorrhage.

Retinal Hemorrhage

Retinal hemorrhage is a significant marker indicating a local or systemic vascular abnormality that requires thorough investigation. Retinal hemorrhages can occur at various locations, including:

1. Flame-shaped hemorrhages, which are located in the nerve fiber layer.

2. Dot and blot hemorrhages, which are located in the outer plexiform layer-inner nuclear layer complex.

3. Subhyaloid hemorrhages, which occur between the internal limiting and posterior hyaloid membranes, presenting a boat-shaped configuration.

4. Subretinal pigment epithelium hemorrhages, which are located between the retinal pigment epithelium (RPE) and the Bruch membrane.

5. Subretinal hemorrhages, which are located between the RPE and the photoreceptor layer. (Please see StatPearls' companion resource, "Retinal Hemorrhage," for more information.)

Disc Hemorrhage

Disc hemorrhage, also known as Drance hemorrhage, is characterized by a linear hemorrhage that is perpendicular to the optic disc. The most common locations for disc hemorrhages are at the superotemporal or inferotemporal margins.

Submacular Hemorrhage

Submacular hemorrhage occurs due to abnormalities in the choroidal and retinal vessels, often resulting from a choroidal neovascular membrane associated with age-related macular degeneration (ARMD). This type of hemorrhage directly affects the quality of vision.