Other authors suggest various vascular etiologies, for example, ischemic microinfarction in the optic nerve head or perturbation of the blood-retinal barrier. The hemorrhage is a secondary event resulting from tissue damage. Essentially, this theory suggests that the primary insult is neurodegenerative, causing changes or stretching of connective tissue, remodeling of lamina cribosa, and/or traction from glial scar formation, which in turn damages the microvascular network leading to hemorrhage. Proponents of the mechanical theory hypothesize that disc hemorrhages result from mechanical shearing at the lamina cribrosa or damage to the capillary network at the border of retinal nerve fiber layer defect enlargement. Two primary hypotheses exist: mechanical and ischemic vascular. Etiology and Pathophysiology Mechanical and Vascular HypothesesĪlthough disc hemorrhages have been the subject of tremendous research, the exact mechanism by which they appear remains elusive. Less commonly, a disc hemorrhage may be noted in the peripapillary retinal nerve fiber layer reaching within one disc diameter of the optic disc margin. Alternately, deeper disc hemorrhages may appear round and blotchy. Classically, these hemorrhages are located in the prelaminar optic disc, cross the peripapillary zone, and extend into the adjacent superficial retinal nerve fiber layer, although they may not occupy the entire length from disc to retina. 9.2.2 Recurrent Disc Hemorrhages: The two-population hypothesisĪlternate names: optic disc hemorrhage, Drance hemorrhage, splinter hemorrhage, nerve fiber layer hemorrhage, optic nerve head hemorrhage.ĭisc hemorrhages are splinter or flame-shaped hemorrhages oriented perpendicular to the optic disc margin ( Figure 1).

9.1.1 Do all individuals with disc hemorrhage develop glaucoma?.

5 Physical Examination and Clinical Diagnosis.

Nova Southeastern University, Davie, Florida, USA Peripheral Retinal Hemorrhages - When it's not Ocular Ischemic Syndrome Clinicians should be aware of this rare condition and its unique clinical presentation. PEHCR is a rare, but symmetrical retinal degeneration that may present with isolated subretinal hemorrhages in the peripheral retina. Despite the low prevalence (2,100 people affected each year), clinicians usually suspect OIS when they identify midperipheral and peripheral retinal hemorrhages. Due to the overall clinical picture, we asked the patient to seek consultation with a retinologist for fluoresecein angiography (IVFA), optical coherence tomography (OCT) and to determine if treatment with anti-VEGF agents was deemed necessary. DFE of the periphery revealed a subretinal hemorrhage and scar due to a resolved subretinal hemorrhage OD and pre-retinal hemorrhage and scar due to a resolved subretinal hemorrhage OS. DFE revealed macula geographic atrophy and isolated, midperipheral dot and blot hemorrhages OU. A 79-year old white female presented with complaints of difficulty reading up close and seeing faces at intermediate and far distances. Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is an uncommon, but symmetrical peripheral retinal degeneration that may vary in presentation from peripheral retinal pigment epithelial mottling, subretinal fluid or hemorrhage to vitreous hemorrhages.

Without anterior segment findings, a diagnosis of OIS is unlikely. The clinical presentation of OIS includes anterior and posterior segments findings, such as corneal edema, uveitis, hypotony, rubeosis and midperipheral dot and blot hemorrhages.

Ocular Ischemic Syndrome (OIS) is usually the initial differential diagnosis when retinal hemorrhages are identified in the midperipheral or peripheral retina.

Dot and blot hemorrhages causes