Cause Of Retinal Hemorrhage Research Articles

Лечебно-профилактические мероприятия витреоретинальных кровоизлияний различной этиологии

Retinal hemorrhages, varying in area of damage and localization in the fundus, are the result of many diseases. Studying the etiology of retinal hemorrhages will allow developing more effective methods of prevention and treatment. Purpose. To study the prevalence of retinal hemorrhages in individuals with rhinological pathology. Material and methods. 1332 people were examined as part of the annual medical examination of civil servants. In addition to routine research ophthalmologist methods, a questionnaire was developed with questions regarding the presence of possible causes of retinal hemorrhages. Results. Traces of peripapillary hemorrhages were diagnosed in 128 eyes (9.5 %). Among them, in 24 people (18.4 %), traces of hemorrhages were in two eyes, while in one eye the size of changes in the peripapillary retina was larger. Hemorrhages were presented in the form of black blood clots or areas of intense black pigmentation in the peripapillary region around the optic disc. The prevalence of hemorrhages ranged from 1 hour to half the diameter of the optic disc and more. Vitreoretinal hemorrhages among all the examined individuals were found on the periphery of the fundus in 11 patients. These patients did not make any complaints, their visual acuity did not change. With the help of a specially designed questionnaire, the causes of hemorrhages were clarified. It was found that in 58,6 % of cases, rynologic pathology was a possible cause, including COVID-19, acute respiratory viral infections, vasomotor rhinitis, curvature of the nasal septum. Other causes include hypertension, prolonged use of anticoagulants, trips to other climatic regions, power sports, intestinal disorders, general anesthesia during surgery. Myopia of medium and high degree was diagnosed in 13.2 %. Conclusions. The point of view is expressed that successive links of pathogenesis in the form of phenomena Valsalva follow nasal breathing disorders is the most common cause of retinal hemorrhages. Keywords: peripapillary hemorrhage, COVID-19, nasal breathing disorder, phenomena Valsalva

Retinal hemorrhage after pediatric neurosurgical procedures

Neurosurgical procedures may occur prior to eye examination in children with suspected abusive head trauma and raise questions by child abuse physicians and ophthalmologists regarding the contribution of neurosurgery to retinal hemorrhage found postoperatively. The purpose of this study was to determine the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention in children. We conducted a retrospective cohort study of children undergoing neurosurgery who had postoperative ophthalmoscopy. Some children were also examined preoperatively. Primary outcome measures were the prevalence and patterns of retinal hemorrhage attributable to neurosurgical intervention. Medical records were reviewed to identify confounding coexistent diseases. Among 267 children undergoing 289 neurosurgical procedures, there were no cases in which children had post-procedural retinal hemorrhage that could be attributed to neurosurgery. Retinal hemorrhage was seen in 32 (12%) cases, but in every case they were either already present on preoperative examination (13 cases) or matched the pattern of a coexistent known cause of retinal hemorrhage, including head trauma with unambiguous history and/or nonocular signs (13), hydrocephalus-related increased intracranial pressure with papilledema-associated peripapillary retinal hemorrhage (5), and retinopathy of prematurity ridge-associated retinal hemorrhage (1). No retinal hemorrhage could be attributed only to neurosurgery. Although children undergoing child abuse evaluations may have intracranial hemorrhage requiring neurosurgery that occurs before a dilated retinal examination can be performed, our data suggest that neurosurgery independently is unlikely to produce retinal hemorrhage and therefore is not a significant confounding factor in the interpretation of retinal hemorrhage patterns in child abuse evaluations.

Retinal Findings in Young Children With Increased Intracranial Pressure From Nontraumatic Causes.

Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP. We conducted a prospective, multicenter study of children <4 years old with newly diagnosed increased ICP as determined by using direct measurement and/or clinical criteria. Infants who were premature, neonates, and suspected survivors of abusive head trauma were excluded on the basis of nonocular findings. Fundus examinations were performed; extent, number, and type of RH in each of 4 distinct retinal zones were recorded. Fifty-six children (27 boys) were studied (mean age 15.4 months; range 1-43 months). All of the children had elevated ICP that required intervention. One child had papilledema. No child (0%; 95% confidence interval: 0%-6.4%) or eye (0%; 95% confidence interval: 0%-3.3%) was found to have an RH. Causes of increased ICP included hydrocephalus, intraventricular hemorrhage, congenital malformations, malfunctioning shunts, and the presence of intracranial space-occupying lesions. Although acute increased ICP can present in children with a pattern of peripapillary superficial RHs in the presence of papilledema, our study supports the conclusion that RHs rarely occur in the absence of optic disc swelling and do not present beyond the peripapillary area in the entities we have studied.

Patterns of retinal hemorrhage associated with pediatric cerebral sinovenous thrombosis

Cerebral sinovenous thrombosis (CSVT) has been proposed as an alternative cause of retinal hemorrhage (RH) in children being evaluated for abusive head trauma. This study investigated the prevalence and characteristics of RH in children with CSVT. The medical records of children >6weeks of age with newly diagnosed CSVT and fundus examination by an ophthalmologist were examined retrospectively. Primary outcomes were presence and patterns of RH. A total of 29 children (median age, 9years; range, 7weeks to 17years) were studied. Of these, 5 (17%) had RH, in 4 of whom RH were peripapillary, superficial, intraretinal, and adjacent to a swollen optic disk. In the fifth child, who had meningitis, sepsis, and multiple cerebral infarcts, there were a moderate number of posterior pole intraretinal hemorrhages. Eighteen children (62%) had optic disk swelling. In 13 children, cerebrospinal fluid opening pressure was recorded (range, 27-59cm H2O). CSVT risk factors included meningitis, mastoiditis, and hypercoagulability. RH in pediatric CSVT was uncommon. When RHs were present, the appearance matched RH patterns known to be caused by medical conditions, such as raised intracranial pressure and sepsis, also present in these children. These findings suggest that the RHs are due to these other causes and not directly to CSVT itself. In children with CSVT, if RHs are multilayered, extend beyond the peripapillary region into the rest of the posterior pole or retinal periphery, or occur in the absence of optic disk swelling, another etiology for the RH should be sought.

Relationship between HbA1c and risk of retinal hemorrhage in the Japanese general population: The Circulatory Risk in Communities Study (CIRCS)

AimsRetinal hemorrhage is an important finding on fundus photography. Diabetes mellitus is a cause of retinal hemorrhage, although other causes exist. We sought to better characterize the association between retinal hemorrhage and HbA1c in the Japanese population. MethodsWe conducted a prospective study of 11,644 Japanese men and women aged 30–78years between 2001 and 2011. Fundus photography was performed as part of an annual cardiovascular disease risk survey. HbA1c was determined by the latex coagulation method throughout the study. We used logistic regression models to examine the association between HbA1c and the risk of retinal hemorrhage and diabetic retinal hemorrhage. ResultsDuring a median follow-up period of 4.6years, 509 retinal hemorrhages, including 96 diabetic retinal hemorrhages, were diagnosed. HbA1c was positively associated with the risk of retinal hemorrhage and diabetic retinal hemorrhage among subjects not taking medication for diabetes mellitus at baseline, but not among subjects who were taking medication at baseline. ConclusionsHbA1c was positively associated with the risk of retinal hemorrhage and the subcategory of diabetic retinal hemorrhage among subjects not taking medication for diabetes mellitus at baseline. The association was evident for diabetic retinal hemorrhage, compared with retinal hemorrhage.

Evaluation of Temporal Association Between Vaccinations and Retinal Hemorrhage in Children.

Vaccinations have been proposed as a cause of retinal hemorrhage in children, primarily as part of a defense strategy in high-stakes abusive head trauma cases. If vaccination injections cause retinal hemorrhage, this consideration would affect the evaluation of children for suspected child abuse. To describe the prevalence and causes of retinal hemorrhage among infants and young children in an outpatient ophthalmology clinic and to test the hypothesis that, if vaccination injections cause retinal hemorrhage, then retinal hemorrhage would be seen frequently and be temporally associated with immunization. Retrospective cohort study between June 1, 2009, and August 30, 2012, at The Children's Hospital of Philadelphia pediatric ophthalmology clinics among 5177 children 1 to 23 months old undergoing a dilated fundus examination as an outpatient for any reason. Children with intraocular surgery or active retinal neovascularization were excluded from the study. The prevalence and causes of retinal hemorrhage, as well as the temporal association between vaccination injection within 7, 14, or 21 days preceding examination and retinal hemorrhage. Among 7675 outpatient fundus examinations, 9 of 5177 children had retinal hemorrhage for a prevalence of 0.17% (95% CI, 0.09%-0.33%). All 9 had abusive head trauma diagnosable with nonocular findings. Among a subset of 2210 children who had complete immunization records and underwent 3425 fundoscopic examinations, 163 children had an eye examination within 7 days of vaccination, 323 within 14 days, and 494 within 21 days. No children had retinal hemorrhage within 7 days of vaccination, 1 child had hemorrhage within 14 days, and no additional child had hemorrhage within 21 days. There was no temporal association between vaccination injection and retinal hemorrhage in the prior 7 days (P > .99), 14 days (P = .33), or 21 days (P = .46). Retinal hemorrhage was rare among outpatients younger than 2 years. Considering both immediate and delayed effects, no temporal association existed between vaccination injection and retinal hemorrhage. Vaccination injections should not be considered a potential cause of retinal hemorrhage in children, and this unsupported theory should not be accepted clinically or in legal proceedings. Ophthalmologists noting incidental retinal hemorrhage on an outpatient examination should consider a child abuse evaluation in the absence of other known ocular or medical disease.

Evaluation of optic nerve compression as a potential cause of retinal hemorrhage in infants

Evaluation of optic nerve compression as a potential cause of retinal hemorrhage in infants

The eye in child abuse: key points on retinal hemorrhages and abusive head trauma.

This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP). Children undergoing LP as part of their routine clinical care were studied prospectively at the Children's Hospital of Philadelphia and retrospectively at Nationwide Children's Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) ≥ 20 cm of water (cm H2O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist. One hundred children were studied (mean age: 12 years; range: 3-17 years). Mean OP was 35 cm H2O (range: 20-56 cm H2O); 68 (68%) children had OP >28 cm H2O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H2O). Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause.

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

Dear Editor, We read with great interest the article titled “Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura” by Majji et al.[1] We would like to share our experience in a similar case. The patient, a 56-year-old male was a known case of diabetes, hypertension and presented to us with blurring of vision in both eyes since 10 days. On examination, his best corrected visual acuity (BCVA) was 20/30, N8 in the right eye and 20/50,N12 in the left eye. Anterior segment examination was normal except for nuclear sclerosis Grade 1. Fundus examination of both eyes revealed intraretinal dot and blot hemorrhages suggestive of non-proliferative diabetic retinopathy, but could not account for the presence of subhyaloid hemorrhage and subretinal hemorrhage without any clinical evidence of neovascularization [Figs 1 and 2]. Fundus fluorescein angiogram (FFA) confirmed absence of neovascularization. Patient was examined by a hematologist for systemic evaluation and underwent routine blood counts, peripheral blood smear examination and bone marrow aspiration biopsy. His platelet count was 42,000/cmm, hemoglobin (Hb) level was 10.8 g% and bone marrow aspiration study revealed normocytic, normochromic anemia with plenty of megakaryocytes suggestive of platelet deficiency. He was diagnosed to have normocytic, normochromic anemia with idiopathic thrombocytopenic purpura (ITP). He received platelet transfusion followed by oral steroids. After one month, his platelet count increased to 2.15 lakh/cmm and was accompanied by resolution of retinal hemorrhages to a great extent. At final follow-up (three months after first presentation), BCVA improved to 20/20, N6 and 20/40, N10 in the right and left eye respectively, with platelet count of 2.5 lakh/cmm and fundus examination revealed marked resolution of hemorrhages [Figs 3 and 4].Figure 1: Fundus photo of right eye showing pre retinal and subretinal hemorrhages before treatment of ITPFigure 2: Fundus photo of left eye showing pre retinal and subretinal hemorrhages before treatment of ITPFigure 3: Fundus photo of right eye showing marked resolution of hemorrhages after treatment of ITPFigure 4: Fundus photo of left eye showing marked resolution of hemorrhage after treatment of ITPITP is known to cause vitreo-retinal and subretinal hemorrhages.[2–4] Retinal hemorrhages could be the first clinical manifestation as noted in our patient.[1] Oral corticosteroids and platelet transfusion administered in the initial management of ITP help in the resolution of vitreo-retinal hemorrhages as noted in our patient.[4] Though it is not uncommon to find retinal and / or subretinal hemorrhages in patients with ITP, FFA would be an important diagnostic tool in a patient with ITP and coincidental diabetic retinopathy to ascertain the cause of retinal hemorrhages.

Unilateral Retinal Hemorrhages with Subarachnoid Hemorrhage in a 5-Week-Old Infant: Is This Nonaccidental Injury?

Retinal hemorrhages are an important sign in the setting of nonaccidental injury (NAI) (abusive head injury) in young infants and form a very important part of the evidence in support of the diagnosis. The diagnosis of NAI has serious social and legal implications. Other causes of retinal hemorrhages in an infant, such as birth trauma, accidental head injury, subarachnoid hemorrhage, other less common disorders of clotting, leukemia, and infections such as endocarditis, need to be considered and ruled out in making a diagnosis of NAI. Descriptive case report. A 5-week-old child presented with rapid onset of symptoms of drowsiness and hypotonia, unilateral retinal hemorrhages, and an intracranial hemorrhage in the posterior fossa. NAI was high on the list of differential diagnosis, which caused considerable anxiety in the parents. The cause of the intracranial hemorrhage only became apparent at repeat neuroimaging several weeks later. The case is presented to point out arteriovenous malformation as a possible cause of retinal hemorrhages in this age group where an early diagnosis of the etiology is often not possible. A diagnosis of NAI, commonly associated with a similar clinical presentation, can have serious social and legal implications.

Bilateral vitreous hemorrhages in an infant with low fibrinogen levels

The finding of retinal or vitreous hemorrhage in a child under age 3 years may cause significant controversy with regard to the etiology, because it raises the suspicion of nonaccidental injury. Blood dyscrasias have been documented to cause retinal and vitreous hemorrhages in adults and children, but they have rarely been reported to be the cause of retinal hemorrhages in neonates. We report on a patient with a low plasma fibrinogen level who had bilateral retinal hemorrhage that proceeded to vitreous hemorrhage. This subtle abnormality of the blood clotting cascade caused significant retinal and vitreous hemorrhage in a child without risk factors for abuse.

Evidence for Breaches of the Retinal Vasculature in Acquired Immune Deficiency Syndrome Angiopathy: A Fluorescent Microsphere Study

The author studied the retinal vasculature in patients with acquired immune deficiency syndrome (AIDS) by infusion of microspheres impregnated with fluorescent dye. Experimental study of the structural integrity of the retinal microvasculature in 14 autopsy patients with AIDS was compared with age- and gender-matched control retinas. Fourteen autopsy eyes from patients with AIDS, eight autopsy eyes from immunosuppressed control patients, and four autopsy eyes from nonimmunosuppressed control patients were studied. The central retinal arteries of autopsy eyes were perfused with fluorescent microspheres of 10 and 200 nm in diameter. The retinas were dissected from the eyes and viewed by fluorescence microscopy. Vascular breaches permeable to 200-nm microspheres were discovered in eyes from patients with AIDS. Ruptured microaneurysms were identified at the center of retinal hemorrhages in 7 of 14 eyes from patients with AIDS and 5 of 8 immunosuppressed control eyes. Leakage around microaneurysms occurred even in the absence of hemorrhage and were more frequent in eyes from patients with AIDS (11/14) than in control eyes (3/12). Cotton wool patches were surrounded by tortuous retinal vessels and microaneurysms. Ruptured microaneurysms are a frequent cause of retinal hemorrhage in immunosuppressed patients. Breaches in microaneurysms occur even in the absence of hemorrhage. These breaches are often at least 200 nm in diameter, a size that is permissive to capsids and virions of cytomegalovirus (CMV). Ruptured and/or leaky microaneurysms are potential sources of CMV permeation of the blood-retinal barrier. Breaches of the retinal microvasculature are not specific to patients with AIDS and occur frequently in other immunosuppressed patients.