Retinal hemorrhage
Background
- Due to retinal capillary rupture, can be due to acute or chronic processes
Causes[1][2]
- 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: 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