Retinal hemorrhage refers to bleeding or the collection of blood between the layers of the retina. Depending on its localization, it can be classified into the following types 1:
preretinal
intraretinal
subretinal
subretinal pigment epithelial or choroidal
On this page:
Epidemiology
Retinal hemorrhage can be seen in all age groups although etiology will vary depending on the group age:
In childhood, most cases are seen in infants and most are related to trauma:
25- 50% are birth-related 2
~30% are due to suspected physical abuse 3
<5% are due to accidental trauma 4
Approximately 15% of childhood cases are seen in severe disease not related to trauma 5.
In adults, retinal hemorrhages are most commonly seen after 40 years of age, usually as a consequence of a systemic disorder and its prevalence will depend on the underlying cause i.e. ~35% in patients with diabetes mellitus 6, and ~10% in patients with hypertension 7. Other less common causes in adulthood are some ocular diseases (e.g. age-related macular degeneration, polypoidal choroidal vasculopathy, retinal vein occlusion), anemia, leukemia, connective tissue disorders, preeclampsia, bacterial endocarditis, and trauma.
Clinical presentation
The symptoms can vary, depending on the location and extent of the bleeding. Some of the more common manifestations are sudden vision loss, significant blurring vision and floaters. Retinal hemorrhage can also be clinically silent.
Radiographic features
Although usually diagnosed clinically by ophthalmologists, retinal hemorrhage can be visualized on CT and MRI images.
CT is not a sensitive test and should not be considered a reliable diagnostic tool. MRI is more sensitive than CT, especially sequences such as T2* and SWI sequences. The sensitivity varies between 50-75% depending on the studies and on the presence of an orbit-specific SWI sequence 8. Moreover, MRI is highly specific and has a very high positive predictive value 9,10.
CT
Retinal hemorrhage can potentially be visualized as one or more hyperattenuating focus/foci in the posterior portion of the globe.
MRI
Hemorrhage can be visualized on MRI as small foci of susceptibility artifacts along the retina on T2*/GRE/SWI sequences.
Treatment and prognosis
The prognosis depends on the type and the extent of retinal hemorrhage, but a resolution of the condition is usually observed within weeks of diagnosis. Severe hemorrhages, on the other hand, can cause permanent visual loss.
The treatment approach also depends on the type of hemorrhage. Because spontaneous resolution often happens, therapeutic intervention is usually not immediately required. Nevertheless, a prompt diagnosis and intervention on the underlying systemic disorder causing the hemorrhages is required.
Unable to process the form. Check for errors and try again.