Diagnosis is usually made on fundoscopic evaluation. However, it may be overlooked in the setting of severe trauma and subarachnoid haemorrhage. The presence of this entity is predictive of a poor clinical outcome in patients with intracranial haemorrhage.
Intraocular haemorrhage in the setting of subarachnoid haemorrhage is thought to be a consequence of a sudden increase in intracranial pressure causing obstruction of the central retinal vein and retinal venous stasis, which in turn results in intraretinal and vitreous haemorrhages 2.
On CT evaluation, retinal nodularity and crescentic hyperdensity in the posterior globe in association with subarachnoid hemorrhage are highly suggestive of this diagnosis and further ophthalmologic evaluation is recommended.
Treatment and prognosis
There is a strong association with visual field defects and the condition may require operative intervention with vitrectomy, particularly in the setting of bilateral vitreous haemorrhages 3.
History and etymology
This condition is named after Albert Terson, French ophthalmologist, who described it in 1900 4.
- 1. Swallow CE, Tsuruda JS, Digre KB et-al. Terson syndrome: CT evaluation in 12 patients. AJNR Am J Neuroradiol. 1998;19 (4): 743-7. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 2. Ness T, Janknecht P, Berghorn C. Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage. Graefes Arch. Clin. Exp. Ophthalmol. 2005;243 (9): 859-62. doi:10.1007/s00417-005-1131-z - Pubmed citation
- 3. Stiebel-kalish H, Turtel LS, Kupersmith MJ. The natural history of nontraumatic subarachnoid hemorrhage-related intraocular hemorrhages. Retina (Philadelphia, Pa.). 2004;24 (1): 36-40. Retina (Philadelphia, Pa.) (link) - Pubmed citation
- 4. Maguire JI, MPH APMMD, Jaeger EA. Wills Eye Institute 5-Minute Ophthalmology Consult. LWW. ISBN:1608316653. Read it at Google Books - Find it at Amazon