Patient: 21 year old female university student, RE VA sc 10/10, LE VA sc 10/10 . IOP 12 12 mmHg. No RAPD. Ishihara Test 17/17 both eyes. Anterior Segment examination is within normal limits in both eyes.
Ocular medical History: RE visual disturbances.
General Medical History: a thorough workup reveals two abnormal values- Hb 11.2 g/dl and MCV 61.9 fl, no history of systemic illness to explain the event and no history of physical exertion, exposure to high attitude, Valsalva maneuver, or trauma.
Methods: Colour Photography Posterior Segement, FFA.
Findings:
Colour Photography Posterior Segement: RE fundoscopy reveals multiple intraretinal haemorrhages in the posterior pole. Both the optic nerve and the retinal blood vessels are within normal limits. LE fundoscopy is within normal limits.
Fluorescein Angiography: blockage because of the haemorrhages with no leakage.
Colour Photography Posterior Segement: RE fundoscopy, at 1 month f/u patient reports complete resolution of visual disturbances. Most of the haemorrhages had cleared.
Discussion: Hb 11.2 g/dl and MCV 61.9 fl are not considered low enough to cause significant effect on the blood rheology. Retinal haemorrhages due to anaemia usually occur when haemoglobin is lower than 8 g/dl and almost always affects both eyes. The importance of this diagnosis is that the patient can be reassured that treatment is not required and that a return to a good level of visual acuity can be expected.
Literature:
1. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. Vol 2. Philadelphia, PA: Saunders WB; 1994.
2. Gass JDM. Chapter 8: Traumatic retinopathy. Retinal and vitreous hemorrhage associated with subarachnoid and subdural hemorrhages (Terson’s syndrome). In: Gass’s Atlas of Macular Diseases. 5th ed. Elsevier; 2012:724–727.
3. Pruett RC, Carvalho AC, Trempe CL. Microhemorrhagic maculopathy. Arch Ophthalmol 1981;99:425–432.
4. Messmer EP, Wessing A, Ruprecht K, Naumann GO. Solitary intraretinal macular hemorrhage. Graefes Arch Clin Exp Ophthalmol 1984;222:9–12.
5. Pitta CG, Steinert RF, Gragoudas ES, Regan CD. Small unilateral foveal hemorrhages in young adults. Am J Ophthalmol 1980;89:96–102.
6. Oosterhuis JA. Spontaneous retinal hemorrhages. Duane Trans Am Ophthalmol Soc 1972;70:298–313.
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