Retinal hemorrhage

Background

• Due to retinal capillary rupture, can be due to acute or chronic processes

Causes

• Subacute bacterial endocarditis
• Hypertensive retinopathy
• Diabetic retinopathy
• Trauma: nonaccidental trauma (shaken baby syndrome), intracranial hemorrhage, neonatal birth trauma
• Central Retinal Artery Occlusion (CRAO), Central Retinal Vein Occlusion (CRVO)
• Anemia, leukemia, sickle cell anemia
• Anoxia
• Acute mountain sickness
• Carbon monoxide poisoning
• Prolonged intubation during anesthesia
• Connective tissue disease, SLE
• Scurvy, Wernicke-Korsakoff syndrome
• Preeclampsia
• Pentoxifylline
• Ocular decompression following trabeculectomy

Clinical Features

Roth spots due to retinal vein occlusion

• Roth Spots: retinal hemorrhages with white center, seen on fundoscopy
• May be asymptomatic, or cause visual loss

Differential Diagnosis

Acute Vision Loss (Noninflamed)

• Painful
  • Arteritic anterior ischemic optic neuropathy
  • Optic neuritis
  • Temporal arteritis^†
• Painless
  • Amaurosis fugax
  • Central retinal artery occlusion (CRAO)^†
  • Central retinal vein occlusion (CRVO)^†
  • High altitude retinopathy
  • Open-angle glaucoma
  • Posterior reversible encephalopathy syndrome (PRES)
  • Retinal detachment^†
  • Stroke^†
  • Vitreous hemorrhage
  • Traumatic optic neuropathy (although may have pain from the trauma)

^†Emergent Diagnosis

Evaluation

• Workup dependant on clinical presentation

Management

• Treat underlying condition if appropriate