Retinal hemorrhage (UK English: retinal haemorrhage) is a disorder of the eye in which bleeding occurs in the

retina The retina (from la, rete "net") is the innermost, light-sensitive layer of tissue of the eye of most vertebrates and some molluscs. The optics of the eye create a focused two-dimensional image of the visual world on the retina, which then ...

, the light sensitive tissue, located on the back wall of the eye. There are photoreceptor cells in the retina called

rods and cones A photoreceptor cell is a specialized type of neuroepithelial cell found in the retina that is capable of visual phototransduction. The great biological importance of photoreceptors is that they convert light (visible electromagnetic radiati ...

, which transduce light energy into nerve signals that can be processed by the brain to form visual images. Retinal hemorrhage is strongly associated with child abuse in infants and young children and often leaves such abused infants permanently blind. In older children and adults, retinal hemorrhage can be caused by several medical conditions such as hypertension,

retinal vein occlusion Central retinal vein occlusion, also CRVO, is when the central retinal vein becomes occluded, usually through thrombosis. The central retinal vein is the venous equivalent of the central retinal artery and both may become occluded. Since the centr ...

(a blockage of a retinal vein),

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...

leukemia Leukemia ( also spelled leukaemia and pronounced ) is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called ''blasts'' or ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

Signs and symptoms

At the early stage, a retinal hemorrhage may not show any symptom at all. Some symptoms may include: * Seeing

floater Floaters or eye floaters are sometimes visible deposits (e.g., the shadows of tiny structures of protein or other cell debris projected onto the retina) within the eye's vitreous humour ("the vitreous"), which is normally transparent, or betwe ...

s in the vision * Seeing cobwebs in the vision *Seeing haze or shadows * Distorted vision *Rapid flashes of light in peripheral vision *Red tint to vision * Blurriness *Sudden

blindness Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment� ...

*Headache

Causes

In adults, retinal hemorrhages are largely spontaneous, secondary to chronic medical conditions such as hypertension. They also commonly occur in high altitude climbers, most likely due to the effects of systemic hypoxia on the eye. Risk is correlated with the maximum altitude reached, duration of exposure to high altitude conditions, and climb rate. In infants, retinal hemorrhages (RH) are highly associated with child abuse. The incidence of RH in abusive head trauma is approximately 85%. In a comprehensive review of 62 studies comprising 998 children, 504 of whom were abused, RH were found in 78% of cases of abusive head trauma (AHT) versus 5% of the cases of non-abusive head trauma. In a child with head trauma and RH, the odds ratio that this is AHT is 14.7 (95% CI 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT cases compared to 8.3% in non-abusive cases. However these findings are bases on circular reasoning and should be viewed with great caution. The generally accepted body of medical literature is strongly in favor of the tight association between retinal hemorrhages and child abuse, and there is no controversy among mainstream medicine. This is despite the basis of these findings relying on circular reasoning, which is highly concerning. The link between hypoxia and extensive retinal hemorrhages is well established in both adults and neonates, and provides an alternative explanation in many cases where abuse is alleged.

Diagnosis

A retinal hemorrhage is generally diagnosed by using an

ophthalmoscope Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part ...

or fundus camera in order to examine the inside of the eye. A

fluorescein angiography Fluorescein angiography (FA), fluorescent angiography (FAG), or fundus fluorescein angiography (FFA) is a technique for examining the circulation of the retina and choroid (parts of the fundus) using a fluorescent dye and a specialized camera. S ...

test may be conducted, in which a fluorescent dye is often injected into the patient's bloodstream beforehand so the administering ophthalmologist can have a more detailed view and examination on the blood vessels in the retina. The fluorescent dye can have dangerous side effects: see

Fluorescein Fluorescein is an organic compound and dye based on the xanthene tricyclic structural motif, formally belonging to triarylmethine dyes family. It is available as a dark orange/red powder slightly soluble in water and alcohol. It is widely used ...

Eye examination An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ...

may be done to check the eye(s) conditions, for instance to check how well the patient sees straight ahead, off to the sides and at different distances. Blood tests may provide information about the patient's overall health and may also reveal the medical condition that may have caused retinal hemorrhage.

Prevention

It is recommended to consult with ophthalmologist or optometrist as early as possible, particularly for people with vision problems, these includes floaters, flashes, cobwebs or spots in their vision. Preventive measures such as regular prenatal care and monitoring of infants with high risks of the disorder may be done to avoid further complications of retinal hemorrhages in infants. For retinal hemorrhages associated with hypertension, blood pressure can be controlled by having regular blood pressure check ups, frequent exercise, monitor daily food intakes and to practice a stress-free lifestyle.

Treatment

Retinal hemorrhages, especially mild ones not associated with chronic disease, will normally reabsorb without treatment. Laser surgery is a treatment option which uses a laser beam to seal off damaged blood vessels in the retina. Anti-vascular endothelial growth factor (VEGF) drugs like

Avastin Bevacizumab, sold under the brand name Avastin among others, is a medication used to treat a number of types of cancers and a specific eye disease. For cancer, it is given by slow injection into a vein (Intravenous therapy, intravenous) and use ...

and

Lucentis Ranibizumab, sold under the brand name Lucentis among others, is a monoclonal antibody fragment ( Fab) created from the same parent mouse antibody as bevacizumab. It is an anti-angiogenic that is approved to treat the "wet" type of age-related ...

have also been shown to repair retinal hemorrhaging in diabetic patients and patients with hemorrhages associated with new vessel growth. Alternative treatments may include providing necessary nutrients to strengthen and heal damaged blood vessels, through the consumption of dietary supplements such as Vitamins A, B, C and E. Also, the essential fatty acids including omega-3 from fish oil and flaxseed oil.

Signs and symptoms

Causes

Diagnosis

Prevention

Treatment

See also

References

Further reading