Atlas of Ophthalmology

A 21 year old female university student presents with RE visual disturbances. There is no history of systemic illness to explain the event and no history of physical exertion, exposure to high attitude, Valsalva maneuver, or trauma. On examination : 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. 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. A thorough workup reveals two abnormal values- Hgb 11.2 g/dl and MCV 61.9 fl . These values 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. Fluorescein angiography shows blockage because of the haemorrhages with no leakage. At 1 month f/u patient reports complete resolution of visual disturbances. Most of the haemorrhages had cleared. 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. References: 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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