II. Pathophysiology
- Most commonly caused by Diabetic Retinopathy, Eye Trauma or Posterior Vitreous Detachment
- Mechanisms
- Normal blood vessel rupture (e.g. Eye Trauma, Vitreous Detachment, Shaken Baby Syndrome)
- Pathologic structure bleeding (e.g. neovascularized Retina in Diabetic Retinopathy, CRVO)
III. Risk Factors
- Diabetes Mellitus (Diabetic Retinopathy)
- Coagulopathy
- Retinal Tear (from Posterior Vitreous Detachment)
- Proliferative sickle Retinopathy (Sickle Cell Anemia)
- Eye Trauma
- Macular Degeneration
- Retinal artery micro-aneurysm
- Shaken Baby Syndrome
- Central Retinal Vein Occlusion (CRVO)
- Terson Syndrome (associated with Subarachnoid Hemorrhage)
- Occurs in 20-30% of SAH cases, and is associated with a worse prognosis
- Coagulopathy
IV. Symptoms
- Acute Vision Loss lasting for minutes to hours
V. Signs
- Funduscopy
- Red Haze of Fundoscopy obscures the Retina
-
Pupil reflex
- Normal (consider Retinal Detachment if abnormal pupil reflex)
-
Slit Lamp
- Evaluate for Red Blood Cells in anterior chamber
VI. Imaging
-
Ocular Ultrasound
- May reveal Vitreous Hemorrhages
VII. Management
- Urgent ophthalmology evaluation within 24 hours
- Panretinal photocoagulation (for proliferative photocoagulation)
- Pars Plana Vitrectomy (Retinal Detachment)
- Bedrest
- Elevate head of bed to 30 degrees
- Hold Anticoagulants if possible (including Aspirin and NSAIDs)
- Avoid strenuous activity (that might increase Blood Pressure and worsen spontaneous bleeding)
VIII. Management
- Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11