Subhyaloid hemorrhage in association with an atypical central vein occlusion

Abstract

Subhyaloid macular bleeding is a rather rare complication caused by central or branch retinal vein occlusions, by vascular malformations, Terson's syndrome, trauma or valsalva's manoeuver. We report on a young and otherwise healthy patient with a large subhyaloid macular hemorrhage associated with an atypical central vein occlusion. A 25-year old female was evaluated for an acute and dramatic drop of visual acuity of the right eye. The ophthalmological findings included an extensive subhyoidal macular bleeding, congested, tortuous retinal veins and some flame-shaped preretinal haemorrhages along a couple of veins. Furthermore, a slight edema in the area of an inferiorly of the macular region localized cilioretinal artery was visible. The general history of the patient was unremarkable with the exception of smoking. Anamnestically, Valsalva's manoeuver could not be excluded by the patient. Atypical central vein occlusions can be the rare cause of a subhyaloid macular hemorrhage. A Valsalva's manoeuver could have caused in our patient the subhyaloid macular and the preretinal bleedings. The temporarily raised venous pressure could have been responsible for the central vein occlusion, secondarily causing the occlusion of a cilioretinal paramacular artery.