Intraocular hemorrhage
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| Intraocular hemorrhage Classification and external resources | |
 | |
|---|---|
| ICD-10 | H35.6 |
| ICD-9 | 362.81 |
| DiseasesDB | 29369 |
| MeSH | D012166 |
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Ocular Anatomy
The volume of the vitreous in the adult is about 4 cc or 80% of the volume of the eye's globe. Water makes up 99% of the vitreous content. The remaining 1% mostly is composed of collagen and hyaluronic acid which although clear, causes the vitreous to be gelatinous.
The vitreous is attached to the retina in three locations. The vitreous base refers to a 4 mm circular band where the vitreous body attaches to the anterior retina (ora serrata). This is the strongest of the three attachments. The vitreous also attaches in a circular zone around the optic nerve head. This is the second strongest attachment of the vitreous. This attachment becomes progressively weaker with advanced age, and it is this attachment that may become separated in posterior vitreous detachment.
The vitreous is itself avascular and therefore the blood in vitreous hemorrhage comes from organs outside the vitreous. When hemorrhage occurs into the vitreous, it accumulates in potential spaces within and around the vitreous body. These potential spaces for blood to accumulate include the following:
- The retrolental space of Erggelet
- The canal of Petit
- The Cloquet canal
- The bursa premacularis
- The canal of Hannover (between the orbiculoanterocapsular and posterocapsular portions of the zonular fibers)
The borders of the vitreous body are as follows:
Posterior: The internal limiting membrane of the retina
Anterior: The nonpigmented epithelium of the ciliary body, and anteriorly by the lens zonular fibers and posterior lens capsule.
Pathophysiology
The two most common overarching pathophysiologic mechanisms of vitreous hemorrhage involve hemorrhage into the vitreous from a diseased retina or trauma. Specific pathophysiologic mechanisms are discussed below:
Extraocular Causes of Vitreal Hemorrhage
Diabetes and sickle cell disease are obvious extraocular diseases that are associated with retinopathy. Retinopathy is characterized by neovascular vessels, fragile vessels, occluded vessels and ischemic vessels, all of which increase the risk of vitreous hemorrhage. The disorders are associated with retinal ischemia which in turn causes the release of angiogenic growth factors including vascular endothelial growth factor (VEGF), basic fibroblast growth factors (bFGF), and insulin-like growth factor (IGF).
Trauma is another major pathophysiologic mechanism of intraocular hemorrhage.
Conditions that may increase the risk of vitreal hemorrhage also include coagulation disorders (e.g. leukemia and thrombocytopenia). While coagulation disorders may not themselves be primarily associated with bleeding, in the presence of trauma or retinopathy they may secondarily increase the risk of bleeding. Autoimmune / collagen vascular disorders such as Behcets disease and sarcoid have also been associated with an increased risk of intraocular hemorrhage. Thus a careful history should be obtained regarding all these systemic / extraocular causes.
Subretinal Bleeeding with Breakthrough Bleeding into the Vitreous
Other less common pathological mechanisms of vitreous hemorrhage include subretinal bleeding with secondary extension into the vitreous cavity.
Age-related macular degeneration and choroidal melanoma are the two leading causes of vitreous hemorrhage secondary to breakthrough bleeding. Terson syndrome is subarachnoid hemorrhage associated with vitreous bleeding caused by rupture of retinal venules and/or capillaries as a result of a sudden increase in intracranial pressure (which is transmitted to the retinal vasculature via the optic nerve).
Subarachnoid Hemorrhage and Associated Intraocular Hemorhhage
Approximately one of three patients with subarachnoid hemorrhage will sustain an intraocular hemorrhage, and approximately 6% of patients have vitreous hemorrhage.
Terson Syndrome
In this condition, the branches of the central retinal vein or the central retinal vein itself are generally the source of intraocular bleeding. This syndrome occurs predominantly patients aged 30 to 50 years.
Differential Diagnosis of Causes of Intraocular Hemorrhage
In general, vitreous hemorrhage results from tears of the retina or neovascularization of the retina
Common causes in descending order of frequency
Proliferative diabetic retinopathy
Trauma (blunt or penetrating, including shaken baby syndrome/child abuse)
Central retinal vein occlusion
Subarachnoid hemorrhage (Terson syndrome)
Avulsed retinal vessels
Age-related macular degeneration
Radiation retinopathy
Macroaneurysms
Others rare causes of vitreous hemorrhage include the following:
Complications of surgical procedures
Retinal laser photocoagulation
Intruding (scleral erosion) scleral buckle
Globe perforation during retrobulbar or peribulbar surgery/anesthesia
Intraocular lens implantation or removal
Neovascularization from cataract wound
Tumors
Malignant choroidal melanoma
Melanocytoma of optic nerve disc
Astrocytic hamartoma of the retina
Cavernous hemangioma of optic nerve disc
Vascular/neovascular
Coats disease / retinal telangiectasia
Retinopathy of prematurity (ROP)
Ocular ischemic syndrome
Branch retinal artery occlusion
Central retinal artery occlusion
Retinal angiomatosis
Retinal vasculitis
Persistent hyaloid artery
Congenital prepapillary
Vascular loop venous stasis retinopathy
Dominant (familial) exudative vitreoretinopathy
Incontinentia pigmenti
Inflammation
Presumed ocular histoplasmosis syndrome
Eales disease (also known as also known as angiopathia retinae juvenilis, periphlebitis retinae, primary perivasculitis of the retina)
Uveitis (including pars planitis)
Syphilitic retinitis
Systemic lupus erythematosus (SLE)
Hematologic disorders
Idiopathic thrombocytopenia purpura
Thrombotic thrombocytopenic purpura
Disseminated intravascular coagulation
Von Willebrand syndrome
Miscellaneous causes
Talc retinopathy
Retinitis
Pigmentosa Valsalva retinopathy
External links
Sensory system - Visual system - Eye | |
|---|---|
| Fibrous tunic (outer) | Conjunctiva • Sclera • Schlemm's canal • Trabecular meshwork • Limbus Cornea (Epithelium, Bowman's, Stroma, Descemet's, Endothelium) |
| Uvea (middle) | Choroid (Ciliary processes, Choriocapillaris, Bruch's membrane) • Iris (Stroma) • Pupil • Ciliary body |
| Retina (inner) | Macula • Fovea • Optic disc |
| Anterior segment | Anterior chamber • Aqueous humour • Posterior chamber • Lens |
| Posterior segment | Vitreous humour • Zonule of Zinn |
| Intraocular muscles | parasympathetic (Ciliary muscle, Iris sphincter muscle) • sympathetic (Iris dilator muscle) |
Sensory system - Visual system |
|---|
| Eye • Optic nerve • Optic chiasm • Optic tract • Lateral geniculate nucleus • Optic radiation • Visual cortex • Blobs |
Veins (emissary, jugular and others) and sinuses of head and neck (drainage patterns can vary) | |||||
|---|---|---|---|---|---|
| to external jugular | retromandibular: maxillary • superficial temporal (anterior auricular) transverse cervical - suprascapular - anterior jugular (jugular venous arch) | ||||
| to internal jugular |
| ||||
| to vertebral vein | occipital (occipital) • suboccipital venous plexus deep cervical | ||||
| to brachiocephalic | inferior thyroid (inferior laryngeal) - thymic | ||||
Pathology of the eye (primarily H00-H59, 360-379) | |
|---|---|
| Eyelid, lacrimal system and orbit | eyelid: inflammation (Stye, Chalazion, Blepharitis) - Entropion - Ectropion - Lagophthalmos - Blepharochalasis - Ptosis - Blepharophimosis - Xanthelasma - Trichiasis
lacrimal system: Dacryoadenitis - Epiphora - Dacryocystitis orbit: Exophthalmos - Enophthalmos |
| Conjunctiva | Conjunctivitis - Pterygium - Pinguecula - Subconjunctival hemorrhage |
| Sclera and cornea | Scleritis - Keratitis - Corneal ulcer - Snow blindness - Thygeson's superficial punctate keratopathy - Fuchs' dystrophy - Keratoconus - Keratoconjunctivitis sicca - Arc eye - Keratoconjunctivitis - Corneal neovascularization - Kayser-Fleischer ring - Arcus senilis - Band keratopathy |
| Iris and ciliary body | Iritis - Uveitis - Iridocyclitis - Hyphema - Persistent pupillary membrane - Iridodialysis - Synechia |
| Lens | Cataract - Aphakia - Ectopia lentis |
| Choroid and retina | Birdshot chorioretinopathy - Retinitis - Chorioretinitis - Choroideremia - Retinal detachment - Retinoschisis - Retinopathy (Bietti's crystalline dystrophy, Coats disease, Diabetic retinopathy, Hypertensive retinopathy, Retinopathy of prematurity) - Macular degeneration - Retinitis pigmentosa - Retinal haemorrhage - Central serous retinopathy - Macular edema - Epiretinal membrane - Macular pucker - Vitelliform macular dystrophy - Leber's congenital amaurosis |
| Optic nerve and visual pathways | Optic neuritis - Papilledema - Optic atrophy - Leber's hereditary optic neuropathy - Dominant optic atrophy - Optic disc drusen - Glaucoma - Toxic and nutritional optic neuropathy - Anterior ischemic optic neuropathy |
| Ocular muscles, binocular movement, accommodation and refraction | Paralytic strabismus: Ophthalmoparesis - Progressive external ophthalmoplegia - Palsy (III, IV, VI) - Kearns-Sayre syndrome
Other strabismus: Esotropia/Exotropia - Hypertropia - Heterophoria (Esophoria, Exophoria) - Brown's syndrome - Duane syndrome |
| Visual disturbances and blindness | Amblyopia - Leber's congenital amaurosis - Subjective (Asthenopia, Hemeralopia, Photophobia, Scintillating scotoma) - Diplopia - Scotoma - Anopsia (Binasal hemianopsia, Bitemporal hemianopsia, Homonymous hemianopsia, Quadrantanopia) - Color blindness (Achromatopsia) - Nyctalopia (Oguchi disease) - Blindness/Low vision |
| Pupil | Anisocoria - Argyll Robertson pupil - Marcus Gunn pupil/Marcus Gunn phenomenon - Adie syndrome |
| Infectious diseases | Trachoma - Onchocerciasis |
| Other | Nystagmus - Miosis - Mydriasis - Glaucoma - Ocular hypertension - Floater - Leber's hereditary optic neuropathy - Red eye - Keratomycosis - Xerophthalmia - Aniridia |
| See also congenital | |
WikiDoc Research Resources for Intraocular hemorrhage (Click show to right to view) | |
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| Articles on Intraocular hemorrhage | Most recent articles on Intraocular hemorrhage • Most cited articles on Intraocular hemorrhage • Review articles on Intraocular hemorrhage • Articles on Intraocular hemorrhage in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Intraocular hemorrhage | Powerpoint slides on Intraocular hemorrhage • Images of Intraocular hemorrhage • Photos of Intraocular hemorrhage • Podcasts & MP3s on Intraocular hemorrhage • Videos on Intraocular hemorrhage |
| Evidence Based Medicine Regarding Intraocular hemorrhage | Cochrane Collaboration on Intraocular hemorrhage • Bandolier on Intraocular hemorrhage • TRIP on Intraocular hemorrhage |
| Cost Effectiveness of Intraocular hemorrhage | Cost Effectiveness of Intraocular hemorrhage |
| Clinical Trials Involving Intraocular hemorrhage | Ongoing Trials on Intraocular hemorrhage at Clinical Trials.gov • Trial results on Intraocular hemorrhage • Clinical Trials on Intraocular hemorrhage at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Intraocular hemorrhage | US National Guidelines Clearinghouse on Intraocular hemorrhage • NICE Guidance on Intraocular hemorrhage • NHS PRODIGY Guidance • FDA on Intraocular hemorrhage • CDC on Intraocular hemorrhage |
| Textbook Information on Intraocular hemorrhage | Books and Textbook Information on Intraocular hemorrhage |
| Pharmacology Resources on Intraocular hemorrhage | Dosing of Intraocular hemorrhage • Drug interactions with Intraocular hemorrhage • Side effects of Intraocular hemorrhage • Allergic reactions to Intraocular hemorrhage • Overdose information on Intraocular hemorrhage • Carcinogenicity information on Intraocular hemorrhage • Intraocular hemorrhage in pregnancy • Pharmacokinetics of Intraocular hemorrhage • |
| Genetics, Pharmacogenomics, and Proteinomics of Intraocular hemorrhage | Genetics of Intraocular hemorrhage • Pharmacogenomics of Intraocular hemorrhage • Proteomics of Intraocular hemorrhage |
| Newstories on Intraocular hemorrhage | Intraocular hemorrhage in the news • Be alerted to news on Intraocular hemorrhage • News trends on Intraocular hemorrhage |
| Commentary on Intraocular hemorrhage | Blogs on Intraocular hemorrhage |
| Patient Resources on Intraocular hemorrhage | Patient resources on Intraocular hemorrhage • Discussion groups on Intraocular hemorrhage • Patient Handouts on Intraocular hemorrhage • Directions to Hospitals Treating Intraocular hemorrhage • Risk calculators and risk factors for Intraocular hemorrhage |
| Healthcare Provider Resources on Intraocular hemorrhage | Symptoms of Intraocular hemorrhage • Causes & Risk Factors for Intraocular hemorrhage • Diagnostic studies for Intraocular hemorrhage • Treatment of Intraocular hemorrhage |
| Continuing Medical Education (CME) Programs on Intraocular hemorrhage | CME Programs on Intraocular hemorrhage |
| International Resources on Intraocular hemorrhage | Intraocular hemorrhage en Espanol • Intraocular hemorrhage en Francais |
| Business Resources on Intraocular hemorrhage | Intraocular hemorrhage in the Marketplace • Patents on Intraocular hemorrhage |
| Informatics Resources on Intraocular hemorrhage | List of terms related to Intraocular hemorrhage |
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