Spontaneous hyphaema secondary to bleeding from an iris vascular tuft in a patient with a supratherapeutic International normalised ratio: case report

Kenneth G J Ooi,Samuel Dance,Armand Borovik,Sarah B Wang,Ian C Francis,Rohan Gupta

doi:10.1186/s12886-015-0050-y

Kenneth G J Ooi, Samuel Dance + Show 4 more

Open Access

https://doi.org/10.1186/s12886-015-0050-y

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Abstract

BackgroundIris vascular tufts are rare iris stromal vascular hamartomas. Patients with iris vascular tufts generally remain asymptomatic until presenting with a spontaneous hyphaema or with mild intraoperative pupil margin haemorrhage during anterior segment surgery. This is the first reported case of spontaneous hyphaema from iris vascular tuft related to a documented supratherapeutic International Normalised Ratio as a predisposing factor. At 86 years of age, this patient also represents the oldest documented first occurrence of bleeding from an iris vascular tuft.Case presentationAn 86 year old Caucasian lady presented with sudden and persisting loss of vision in her right eye, ocular pain and vomiting. She had a supratherapeutic International Normalised Ratio of 3.9 related to Warfarin use. Her intraocular pressure in the right eye was raised at 55 mmHg, with a 1.6 mm hyphaema and multiple iris vascular tufts visible around the entire pupil.ConclusionThe present case highlights the risk of anticoagulation therapy as a predisposing factor for spontaneous hyphaema and adds to the management considerations for this condition. It also demonstrates the need for Ophthalmologists to be aware of iris vascular tufts as a cause for spontaneous hyphaema, independent of age and systemic associations.

Highlights

Iris vascular tufts are rare iris stromal vascular hamartomas
The present case highlights the risk of anticoagulation therapy as a predisposing factor for spontaneous hyphaema and adds to the management considerations for this condition
It demonstrates the need for Ophthalmologists to be aware of iris vascular tufts as a cause for spontaneous hyphaema, independent of age and systemic associations

Summary

Conclusion

Most patients with IVTs remain undiagnosed, and of those patients in whom the condition is detected, few receive any treatment. The age of our patient at 86 years was unusual and represents the oldest documented first occurrence of bleeding from an IVT Her presentation underscores the need for the Ophthalmologist to be aware of IVTs as a cause for spontaneous hyphaema, independent of age and systemic associations thereof. This case adds to the management considerations for this condition, and demonstrates, as with unexpected bleeding from any site, that the possibility of the patient being over-anticoagulated should always be considered.

Background