Haemorrhage Causing Retinal Damage

Retinal haemorrhage is a disorder of the eye in which bleeding occurs in the retina, the light sensitive tissue, located on the back wall of the eye. There are photoreceptor cells in the retina called rods and cones, which transduce light energy into nerve signals that can be processed by the brain to form visual images. Retinal hemorrhage can affect adults, and newborn babies and infants may also suffer from this disorder.

The location, size, and distribution of the hemorrhages provide clues to the etiology and uncover underlying systemic disorders such as vascular disease, hematologic disorders, and dyscrasias, infections, trauma, or hypoxia. Rarely it can also be seen idiopathically. Most require a detailed systemic work up to detect the underlying cause for the hemorrhages. Management consists of observation, treating the primary cause, and intraocular management to reduce the ischemic and neovascularization sequelae following the hemorrhages.

Treatment

A solitary retinal hemorrhage can be observed and followed up for progression in size and number. Hemorrhages that do not obscure or threaten vision do not warrant immediate treatment and the primary systemic disorder causing the hemorrhages needs to be diagnosed and addressed. Direct intervention for retinal hemorrhages is indicated in submacular, subhyaloid, and vitreous hemorrhages because of their potential to damage vision irreversibly.

Most dot and blot, splinter, and flame-shaped hemorrhages are not vision-threatening and are usually found in the posterior pole sparing the fovea and can be observed. Hemorrhages seen in retinal vein occlusions are not treated per se, but the retinal edema or the neovascularization, which follows as a sequela, needs to be treated. Roth spots are generally asymptomatic and typically resolve with treatment of the underlying disease, especially subacute bacterial endocarditis.

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