Optic disc haemorrhage and posterior vitreous haemorrhage from an acute posterior vitreous detachment


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An optic disc haemorrhage has been defined as a bleeding located in the intrapapillary region and often touching or extending beyond the disc border.1,2 In population-based studies, 20% of observed disc haemorrhages was detected in glaucomatous optic discs, and 80% of disc bleedings occurred in eyes with a normal optic nerve head appearance.3 Because a glaucomatous disc haemorrhage is associated with a high probability of progression of glaucoma,4 it is clinically important to differentiate between a glaucomatous disc haemorrhage and a non-glaucomatous disc bleeding. This report describes the features of an acute non-glaucomatous disc haemorrhage.

A 62-year-old man with a myopic refractive error of −3.00 dioptres suddenly noticed photopsias; a large, dense, localized, ring-like floater moving around the central visual field and a diffuse semi-transparent cloud of floaters and tiny green dots (corresponding to the entoptic phenomenon of erythrocytes) both within and adjacent to the ring, accompanied by a transient flashing light in the peripheral temporal field in the shape of a thin, yellow hemi-circle. This was brought on by eye movement. Ophthalmoscopy revealed a fresh disc haemorrhage at the nasal inferior disc margin. The shape of the haemorrhage was round and not flame-shaped. As shown by the coverage of the retinal vessels, the haemorrhage was located on the surface of the retina and not in the retinal nerve fibre layer (Fig. 1). The optic disc appearance was normal, without signs of glaucomatous optic nerve damage.5 Optical coherence tomography revealed an elevation of retinal tissue at the site of the disc haemorrhage and at the previous posterior vitreous attachment at the nasal disc margin, which may have exerted a traction on the tissue of the optic disc and adjacent retina (Fig. 2a).

Figure 1.

Optic disc photograph showing a fresh disc haemorrhage at the nasal inferior disc margin. Note: haemorrhage is round and not flame-shaped; located epiretinally (and not in the retinal nerve fibre layer) as shown by covering retinal vessels.

Figure 2.

(a) Optic coherence tomogram of the optic nerve head showing the elevation of the retinal tissue at the site of the disc haemorrhage and the previous posterior vitreous attachment, which exerted an acute traction onto the tissue of the optic disc and adjacent retina. (b) Visualization of intravitreally located erythrocytes in the space above the previous vitreo-papillary traction at the nasal disc margin.

The round and not flame-shaped shape of the disc haemorrhage and its location on the retinal surface differentiated it from a glaucomatous disc haemorrhage. The latter is usually flame-shaped and correspondingly, located in the retinal nerve fibre layer.1–3,5 The ophthalmoscopic appearance of the disc haemorrhage in our patient with an acute partial posterior vitreous detachment may be helpful in giving clues for the differentiation between glaucomatous versus non-glaucomatous optic disc haemorrhages.