Intraocular hemorrhage: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(4 intermediate revisions by 2 users not shown)
Line 6: Line 6:
}}
}}
{{SI}}
{{SI}}
{{CMG}}
{{CMG}}{{AE}} {{LRO}}


==Ocular Anatomy==
==Ocular Anatomy==
Line 48: Line 48:


==Causes==
==Causes==
In general, vitreous hemorrhage results from tears of the retina or neovascularization of the retina
===Common Causes===
 
===Common Causes in Descending Order of Frequency===
*Proliferative [[diabetic retinopathy]]
*Proliferative [[diabetic retinopathy]]
*[[Posterior vitreous detachment]]
*[[Posterior vitreous detachment]]
Line 63: Line 61:
*Macro[[aneurysm]]s
*Macro[[aneurysm]]s


===Others Rare Causes of Vitreous Hemorrhage Include the Following===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Avulsed retinal vessels]],  [[Branch retinal artery occlusion]],  [[Central retinal artery occlusion]],  [[Central retinal vein occlusion]],  [[Disseminated intravascular coagulation]],  [[Dominant exudative vitreoretinopathy]],  [[Eales disease ]],  [[Hypertensive retinopathy]],  [[Macroaneurysms]],  [[Neovascularization]],  [[Ocular ischemic syndrome]],  [[Persistent hyaloid artery]],  [[Retinal vasculitis]],  [[Thrombolysis]],  [[Vascular loop venous stasis retinopathy]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Talc retinopathy]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Behçet disease]], [[Cavernous hemangioma ]], [[Melanocytoma ]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Anticoagulants]],  [[Antiphospholipid antibodies]],  [[Drug side effect]],  [[Ocriplasmin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[High altitude]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Astrocytic hamartoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Incontinentia pigmenti]],  [[Norrie disease]],  [[Sarcoid posterior uveitis]],  [[Von willebrand syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Anticoagulants]],  [[Antiphospholipid antibodies]],  [[Coats disease ]],  [[Congenital prepapillary]],  [[Hemophilia]],  [[Hyperviscosity syndrome]],  [[Idiopathic thrombocytopenia purpura]],  [[Leukemia]],  [[Proliferative sickle cell retinopathy]],  [[Retinal angiomatosis]],  [[Retinal macroaneurysm rupture]],  [[Subarachnoid hemorrhage ]],  [[Thrombocytopenia]],  [[Thrombotic thrombocytopenic purpura]],  [[Von willebrand syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Intraocular lens implantation ]],  [[Intraocular lens removal]],  [[Intruding scleral buckle]],  [[Radiation retinopathy]],  [[Retinal laser photocoagulation]],  [[Trabeculectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Presumed ocular histoplasmosis syndrome]],  [[Syphilitic retinitis]],  [[Toxocara]],  [[Uveitis ]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Dermatomyositis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Cavernous hemangioma ]],  [[Macroaneurysms]],  [[Subarachnoid hemorrhage ]],  [[Thrombolysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Proliferative diabetic retinopathy]],  [[Protein c deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Astrocytic hamartoma ]],  [[Leukemia]],  [[Malignant choroidal melanoma]],  [[Melanocytoma ]],  [[Retinoblastoma]],  [[Tumors]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| [[Age-related macular degeneration]],  [[Avulsed retinal vessels]],  [[Branch retinal artery occlusion]],  [[Central retinal artery occlusion]],  [[Central retinal vein occlusion]],  [[Coats disease ]],  [[Congenital prepapillary]],  [[Dominant exudative vitreoretinopathy]],  [[Eales disease ]],  [[Globe perforation]],  [[Hypertensive retinopathy]],  [[Intraocular lens implantation ]],  [[Intraocular lens removal]],  [[Intruding scleral buckle]],  [[Malignant choroidal melanoma]],  [[Norrie disease]],  [[Ocular ischemic syndrome]],  [[Orbital fracture]],  [[Persistent hyaloid artery]],  [[Pigmentosa valsalva retinopathy]],  [[Posterior vitreous detachment]],  [[Presumed ocular histoplasmosis syndrome]],  [[Proliferative sickle cell retinopathy]],  [[Proliferative diabetic retinopathy]],  [[Radiation retinopathy]],  [[Retinal angiomatosis]],  [[Retinal detachment]],  [[Retinal macroaneurysm rupture]],  [[Retinal tear]],  [[Retinal laser photocoagulation]],  [[Retinal vasculitis]],  [[Retinitis]],  [[Retinoblastoma]],  [[Retinopathy of prematurity]],  [[Sarcoid posterior uveitis]],  [[Talc retinopathy]],  [[Trabeculectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Behçet disease]],  [[Dermatomyositis]],  [[Inflammation]],  [[Systemic lupus erythematosus ]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[Syphilitic retinitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Globe perforation]],  [[Orbital fracture]],  [[Retinal detachment]],  [[Retinal tear]],  [[Trauma]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}


====Complications of Surgical Procedures====
===Causes in Alphabetical Order===
Retinal [[laser photocoagulation]]
{{columns-list|
 
*[[Age-related macular degeneration]]
Intruding (scleral erosion) [[scleral buckle]]
*[[Anticoagulants]]
 
*[[Antiphospholipid antibodies]]
[[Trabeculectomy]]
*[[Astrocytic hamartoma ]]
 
*[[Avulsed retinal vessels]]
Globe perforation during retrobulbar or peribulbar surgery/anesthesia
*[[Behçet disease]]
 
*[[Branch retinal artery occlusion]]
Intraocular lens implantation or removal
*[[Cavernous hemangioma ]]
 
*[[Central retinal artery occlusion]]
Neovascularization from [[cataract]] wound
*[[Central retinal vein occlusion]]
 
*[[Coats disease ]]
====Tumors====
*[[Congenital prepapillary]]
 
*[[Dermatomyositis]]
Malignant choroidal [[melanoma]]
*[[Disseminated intravascular coagulation]]
 
*[[Dominant exudative vitreoretinopathy]]
[[Melanocytoma]] of optic nerve disc
*[[Drug side effect]]
 
*[[Eales disease ]]
Astrocytic hamartoma of the retina
*[[Globe perforation]]
 
*[[Hemophilia]]
[[Retinoblastoma]]
*[[High altitude]]
 
*[[Hypertensive retinopathy]]
[[Cavernous hemangioma]] of optic nerve disc
*[[Hyperviscosity syndrome]]
 
*[[Idiopathic thrombocytopenia purpura]]
====Vascular/Neovascular====
*[[Incontinentia pigmenti]]
[[Coats disease]] / retinal telangiectasia
*[[Inflammation]]
 
*[[Intraocular lens implantation ]]
[[Retinopathy of prematurity]] (ROP)
*[[Intraocular lens removal]]
 
*[[Intruding scleral buckle]]
Ocular ischemic syndrome
*[[Leukemia]]
 
*[[Macroaneurysms]]
Branch retinal artery occlusion
*[[Malignant choroidal melanoma]]
 
*[[Melanocytoma ]]
[[Central retinal artery]] occlusion
*[[Neovascularization]]
 
*[[Norrie disease]]
Retinal angiomatosis
*[[Ocriplasmin]]
 
*[[Ocular ischemic syndrome]]
Retinal [[vasculitis]]
*[[Orbital fracture]]
 
*[[Persistent hyaloid artery]]
[[Hyperviscosity syndrome]]
*[[Pigmentosa valsalva retinopathy]]
 
*[[Posterior vitreous detachment]]
[[Sarcoid]] posterior [[uveitis]]
*[[Presumed ocular histoplasmosis syndrome]]
 
*[[Proliferative sickle cell retinopathy]]
Persistent hyaloid artery
*[[Proliferative diabetic retinopathy]]
 
*[[Protein c deficiency]]
Congenital prepapillary
*[[Radiation retinopathy]]
 
*[[Retinal angiomatosis]]
Vascular loop venous stasis retinopathy
*[[Retinal detachment]]
 
*[[Retinal macroaneurysm rupture]]
Dominant (familial) exudative vitreoretinopathy
*[[Retinal tear]]
 
*[[Retinal laser photocoagulation]]
Incontinentia pigmenti
*[[Retinal vasculitis]]
 
*[[Retinitis]]
[[Norrie disease]]
*[[Retinoblastoma]]
 
*[[Retinopathy of prematurity]]
====Inflammation====
*[[Sarcoid posterior uveitis]]
[[Behçet disease]]
*[[Subarachnoid hemorrhage ]]
 
*[[Syphilitic retinitis]]
Presumed ocular [[histoplasmosis]] syndrome
*[[Systemic lupus erythematosus ]]
 
*[[Talc retinopathy]]
[[Eales disease]] (also known as also known as [[angiopathia retinae juvenilis]], [[periphlebitis retinae]], [[primary perivasculitis of the retina]])
*[[Thrombocytopenia]]
 
*[[Thrombolysis]]
[[Uveitis]] (including pars planitis)
*[[Thrombotic thrombocytopenic purpura]]
 
*[[Toxocara]]
[[Syphilitic]] retinitis
*[[Trabeculectomy]]
 
*[[Trauma ]]
[[Dermatomyositis]]
*[[Tumors]]
 
*[[Uveitis ]]
[[Systemic lupus erythematosus]] ([[SLE]])
*[[Vascular loop venous stasis retinopathy]]
 
*[[Von willebrand syndrome]]
[[Toxocara]]
}}
 
====Hematologic Disorders====
[[Thrombocytopenia]]
 
[[Idiopathic thrombocytopenia purpura]]
 
[[Thrombotic thrombocytopenic purpura]]
 
[[Leukemia]]
 
[[Hemophilia]]
 
[[Disseminated intravascular coagulation]]
 
[[Protein C deficiency]]
 
[[Antiphospholipid antibodies]]
 
Von Willebrand syndrome
 
====Miscellaneous Causes====
 
* Talc retinopathy
* [[Retinitis]]
* Pigmentosa Valsalva retinopathy
* Drug side effect
:* [[Ocriplasmin]]


==External Links==
==External Links==
Line 181: Line 264:
{{WikiDoc Sources}}
{{WikiDoc Sources}}


[[category:Primary care]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Medical signs]]
[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]

Latest revision as of 22:25, 29 July 2020

Intraocular hemorrhage

WikiDoc Resources for Intraocular hemorrhage

Articles

Most recent articles on Intraocular hemorrhage

Most cited articles on Intraocular hemorrhage

Review articles on Intraocular hemorrhage

Articles on Intraocular hemorrhage in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Intraocular hemorrhage

Images of Intraocular hemorrhage

Photos of Intraocular hemorrhage

Podcasts & MP3s on Intraocular hemorrhage

Videos on Intraocular hemorrhage

Evidence Based Medicine

Cochrane Collaboration on Intraocular hemorrhage

Bandolier on Intraocular hemorrhage

TRIP on Intraocular hemorrhage

Clinical Trials

Ongoing Trials on Intraocular hemorrhage at Clinical Trials.gov

Trial results on Intraocular hemorrhage

Clinical Trials on Intraocular hemorrhage at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Intraocular hemorrhage

NICE Guidance on Intraocular hemorrhage

NHS PRODIGY Guidance

FDA on Intraocular hemorrhage

CDC on Intraocular hemorrhage

Books

Books on Intraocular hemorrhage

News

Intraocular hemorrhage in the news

Be alerted to news on Intraocular hemorrhage

News trends on Intraocular hemorrhage

Commentary

Blogs on Intraocular hemorrhage

Definitions

Definitions of Intraocular hemorrhage

Patient Resources / Community

Patient resources on Intraocular hemorrhage

Discussion groups on Intraocular hemorrhage

Patient Handouts on Intraocular hemorrhage

Directions to Hospitals Treating Intraocular hemorrhage

Risk calculators and risk factors for Intraocular hemorrhage

Healthcare Provider Resources

Symptoms of Intraocular hemorrhage

Causes & Risk Factors for Intraocular hemorrhage

Diagnostic studies for Intraocular hemorrhage

Treatment of Intraocular hemorrhage

Continuing Medical Education (CME)

CME Programs on Intraocular hemorrhage

International

Intraocular hemorrhage en Espanol

Intraocular hemorrhage en Francais

Business

Intraocular hemorrhage in the Marketplace

Patents on Intraocular hemorrhage

Experimental / Informatics

List of terms related to Intraocular hemorrhage

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Ocular Anatomy

The volume of the vitreous in the adult is about 4 cc or 80% of the volume of the eye's globe. Water makes up 99% of the vitreous content. The remaining 1% mostly is composed of collagen and hyaluronic acid which although clear, causes the vitreous to be gelatinous.

The vitreous is attached to the retina in three locations. The vitreous base refers to a 4 mm circular band where the vitreous body attaches to the anterior retina (ora serrata). This is the strongest of the three attachments. The vitreous also attaches in a circular zone around the optic nerve head. This is the second strongest attachment of the vitreous. This attachment becomes progressively weaker with advanced age, and it is this attachment that may become separated in posterior vitreous detachment.

The vitreous is itself avascular and therefore the blood in vitreous hemorrhage comes from organs outside the vitreous. When hemorrhage occurs into the vitreous, it accumulates in potential spaces within and around the vitreous body. These potential spaces for blood to accumulate include the following:

  1. The retrolental space of Erggelet
  2. The canal of Petit
  3. The Cloquet canal
  4. The bursa premacularis
  5. The canal of Hannover (between the orbiculoanterocapsular and posterocapsular portions of the zonular fibers)

The borders of the vitreous body are as follows:

Posterior: The internal limiting membrane of the retina

Anterior: The nonpigmented epithelium of the ciliary body, and anteriorly by the lens zonular fibers and posterior lens capsule.

Pathophysiology

The two most common overarching pathophysiologic mechanisms of vitreous hemorrhage involve hemorrhage into the vitreous from a diseased retina or trauma. Specific pathophysiologic mechanisms are discussed below:

Extraocular Causes of Vitreal Hemorrhage

Diabetes and sickle cell disease are obvious extraocular diseases that are associated with retinopathy. Retinopathy is characterized by neovascular vessels, fragile vessels, occluded vessels and ischemic vessels, all of which increase the risk of vitreous hemorrhage. The disorders are associated with retinal ischemia which in turn causes the release of angiogenic growth factors including vascular endothelial growth factor (VEGF), basic fibroblast growth factors (bFGF), and insulin-like growth factor (IGF).

Trauma is another major pathophysiologic mechanism of intraocular hemorrhage.

Conditions that may increase the risk of vitreal hemorrhage also include coagulation disorders (e.g. leukemia and thrombocytopenia). While coagulation disorders may not themselves be primarily associated with bleeding, in the presence of trauma or retinopathy they may secondarily increase the risk of bleeding. Autoimmune / collagen vascular disorders such as Behcets disease and sarcoid have also been associated with an increased risk of intraocular hemorrhage. Thus a careful history should be obtained regarding all these systemic / extraocular causes.

Subretinal Bleeeding with Breakthrough Bleeding into the Vitreous

Other less common pathological mechanisms of vitreous hemorrhage include subretinal bleeding with secondary extension into the vitreous cavity.

Age-related macular degeneration and choroidal melanoma are the two leading causes of vitreous hemorrhage secondary to breakthrough bleeding. Terson syndrome is subarachnoid hemorrhage associated with vitreous bleeding caused by rupture of retinal venules and/or capillaries as a result of a sudden increase in intracranial pressure (which is transmitted to the retinal vasculature via the optic nerve).

Subarachnoid Hemorrhage and Associated Intraocular Hemorhhage

Approximately one of three patients with subarachnoid hemorrhage will sustain an intraocular hemorrhage, and approximately 6% of patients have vitreous hemorrhage.

Terson Syndrome

In this condition, the branches of the central retinal vein or the central retinal vein itself are generally the source of intraocular bleeding. This syndrome occurs predominantly in patients aged 30 to 50 years.

Causes

Common Causes

Causes by Organ System

Cardiovascular Avulsed retinal vessels, Branch retinal artery occlusion, Central retinal artery occlusion, Central retinal vein occlusion, Disseminated intravascular coagulation, Dominant exudative vitreoretinopathy, Eales disease , Hypertensive retinopathy, Macroaneurysms, Neovascularization, Ocular ischemic syndrome, Persistent hyaloid artery, Retinal vasculitis, Thrombolysis, Vascular loop venous stasis retinopathy
Chemical/Poisoning Talc retinopathy
Dental No underlying causes
Dermatologic Behçet disease, Cavernous hemangioma , Melanocytoma 
Drug Side Effect Anticoagulants, Antiphospholipid antibodies, Drug side effect, Ocriplasmin
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental High altitude
Gastroenterologic Astrocytic hamartoma
Genetic Incontinentia pigmenti, Norrie disease, Sarcoid posterior uveitis, Von willebrand syndrome
Hematologic Anticoagulants, Antiphospholipid antibodies, Coats disease , Congenital prepapillary, Hemophilia, Hyperviscosity syndrome, Idiopathic thrombocytopenia purpura, Leukemia, Proliferative sickle cell retinopathy, Retinal angiomatosis, Retinal macroaneurysm rupture, Subarachnoid hemorrhage , Thrombocytopenia, Thrombotic thrombocytopenic purpura, Von willebrand syndrome
Iatrogenic Intraocular lens implantation , Intraocular lens removal, Intruding scleral buckle, Radiation retinopathy, Retinal laser photocoagulation, Trabeculectomy
Infectious Disease Presumed ocular histoplasmosis syndrome, Syphilitic retinitis, Toxocara, Uveitis 
Musculoskeletal/Orthopedic Dermatomyositis
Neurologic Cavernous hemangioma , Macroaneurysms, Subarachnoid hemorrhage , Thrombolysis
Nutritional/Metabolic Proliferative diabetic retinopathy, Protein c deficiency
Obstetric/Gynecologic No underlying causes
Oncologic Astrocytic hamartoma , Leukemia, Malignant choroidal melanoma, Melanocytoma , Retinoblastoma, Tumors
Ophthalmologic Age-related macular degeneration, Avulsed retinal vessels, Branch retinal artery occlusion, Central retinal artery occlusion, Central retinal vein occlusion, Coats disease , Congenital prepapillary, Dominant exudative vitreoretinopathy, Eales disease , Globe perforation, Hypertensive retinopathy, Intraocular lens implantation , Intraocular lens removal, Intruding scleral buckle, Malignant choroidal melanoma, Norrie disease, Ocular ischemic syndrome, Orbital fracture, Persistent hyaloid artery, Pigmentosa valsalva retinopathy, Posterior vitreous detachment, Presumed ocular histoplasmosis syndrome, Proliferative sickle cell retinopathy, Proliferative diabetic retinopathy, Radiation retinopathy, Retinal angiomatosis, Retinal detachment, Retinal macroaneurysm rupture, Retinal tear, Retinal laser photocoagulation, Retinal vasculitis, Retinitis, Retinoblastoma, Retinopathy of prematurity, Sarcoid posterior uveitis, Talc retinopathy, Trabeculectomy
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Behçet disease, Dermatomyositis, Inflammation, Systemic lupus erythematosus 
Sexual Syphilitic retinitis
Trauma Globe perforation, Orbital fracture, Retinal detachment, Retinal tear, Trauma
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

External Links

References

Template:Eye Template:Visual system Template:Retina Template:Arteries of head and neck Template:Veins of the head and neck


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Intraocular_hemorrhage&oldid=1639935"