The pathogenesis of optic disc splinter haemorrhages: a new hypothesis

Abstract

To describe a hypothesized relationship between optic disc haemorrhages (ODHs) and primary vascular dysregulation (PVD). Observational case report of a patient with classical PVD and five bilateral recurrent ODHs The ODHs were superotemporal in the right eye and inferotemporal in the left; the eyes were otherwise normal. Intraocular pressure (IOP) never exceeded 17 mmHg. Visual fields were normal. Increased blood flow resistivity, a reduced blood flow of the extraocular vessels, a low systemic blood pressure, a cold-induced flow stop of the nailfold capillaries, and elevated endothelin-1 plasma levels were found, all confirming the diagnosis of vascular dysregulation. Optic disc haemorrhages may be due to a disturbed blood-retina barrier rather than to a mechanical rupture of the vessel. This barrier dysfunction may occur in the context of PVD.