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”
- 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:
2. Flame-shape hemorrhages = “Feathered” or linear retina heme
- Location: within nerve fiber layer (resolve around six weeks)
- Possible etiologies:
- Hypertensive retinopathy
- Retinal vein occlusions
- Papilledema
- Normal-tension glaucoma
- Anterior ischemic optic neuropathy
3. Dot-and-blot hemorrhages = “Round” retinal heme
- Location: inner nuclear & outer plexiform layers (resolve time is longer than flame-shaped hemes)
- Possible etiologies:
- Diabetic retinopathy
- Vein occlusion
- Idiopathic juxtafoveal retinal telangiectasis
- Ocular ischemic syndrome
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:
- Choroidal neovascular membrane formation
- Neurosensory or RPE detachments
- Wet age-related macular degeneration
- Choroidal tumors
- Trauma
Reference:
- 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
