4 Most Common Retinal Hemes You’ll Find: Location and Etiology

Retinal hemorrhages are often hallmarks of many ocular and/or systemic diseases. Thus, finding them in asymptomatic patients during comprehensive eye exams may require further evaluation to determine the principle cause. It is crucial to identify and classify various types of hemorrhages because optometric management is influenced by the underlying etiology. The following are the most common categories of retinal hemorrhages and their associated diseases.

1.       Subhyaloid & pre-retinal hemorrhages = “D or boat-shaped retinal heme”

Retinal Heme

  • Location:
    • Subhyaloid heme – between posterior vitreous base & internal limiting membrane.
    • Pre-retinal heme – posterior to internal limiting membrane & anterior to nerve fiber layer.
  • Possible etiologies:
      • Retinal neovascularization
      • Posterior vitreous detachment & retinal breaks (result of tearing the major retinal vessels)
      • Terson’s syndrome (vitreous heme + subarachnoid heme)
      • Retinal trauma
      • Valsalva retinopathy

2.       Flame-shape hemorrhages = “Feathered” or linear retina heme

flame heme


3.      Dot-and-blot hemorrhages = “Round” retinal heme


  • Location: inner nuclear & outer plexiform layers (resolve time is longer than flame-shaped hemes)
  • Possible etiologies:

4.      Subretinal & subretinal pigment epithelium (RPE) hemorrhages = dark color retinal heme


  • Location: beneath neurosensory retina (resolve very slowly)
    • Subretinal heme – heme in space between neurosensory retina & retinal pigment epithelium (have amorphous shape due to absence of firm attachments between neurosensory retina & RPE).
    • Sub-RPE heme – heme located between RPE and Bruch’s membrane (have well-defined borders because of tight cell junctions between RPE cells).
  • Possible etiologies:


  1. Shechtman, D., Kabat, A. “The Many Faces of a Retinal Hemorrhage.” Optometric Management. [Retrieved August 5, 2013] http://www.optometricmanagement.com/articleviewer.aspx?articleid=101343



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