Between 1978 and 1983, 13,890 cataract extractions were performed in Baltimore at JHH and the GBMC with 14 expulsive hemorrhages for an incidence of 0.10%. In the years 1963 through 1983, 180,690 cataract extractions were performed in Taxila, Pakistan with 87 expulsive hemorrhages for an incidence of 0.05%. Reasons for the significant differences in incidence are presented. The six reported cases of bilateral expulsive hemorrhage are reviewed. Four more cases are added. A classification of choroidal hemorrhage is presented.