Asymptomatic peripapillary subretinal hemorrhage: a study of 10 cases.
BACKGROUND
Peripapillary subretinal hemorrhage (PSH) is often found together with optic disc drusen, optic disc edema, peripapillary subretinal neovascular membranes, vitreous traction, and bleeding diatheses. Previous reports have stated that such optic disc hemorrhages are associated with intrapapillary bleeding largely in patients of Asian origin who are visually symptomatic from this process. We have encountered patients with PSH who have clinical features that differ from those described in these reports.


METHODS
This is a retrospective observational case series. Medical records of 10 patients with isolated peripapillary subretinal hemorrhages were reviewed for clinical characteristics and ancillary testing, including demographics, history, complete eye examination, visual fields, fundus photos, ultrasound, and fluorescein angiography (four patients) at presentation and follow-up. We excluded patients with drusen, neovascular membranes, disc edema, and intrapapillary hemorrhages.


RESULTS
There were 10 patients, all white women without visual symptoms, who had isolated, monocular, nasal, or superonasal peripapillary subretinal hemorrhage, a dysplastic crowded-tilted optic disc, myopia, and normal visual function. The hemorrhages resolved without sequelae over 3-6 months. The findings were frequently discovered on routine examination and suspected of representing papilledema.


CONCLUSIONS
We have described a benign syndrome of isolated PSH in crowded and tilted optic discs in myopic eyes of white women. The PSHs do not cause visual symptoms and resolve spontaneously. We propose that an interplay of ocular motor forces, scleral thinning, and vitreopapillary traction acting on a morphologically vulnerable optic disc explains these hemorrhages.
Department of Ophthalmology State University of New York at Stony Brook University Hospital and Medical Center Stony Brook, Stony Brook, New York 11794-8223, USA. patrick.sibony@stonybrook.edu
Patrick
P
Sibony
Stuart
S
Fourman
Robert
R
Honkanen
Fadi
F
El Baba
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008875:Middle Aged; D009216:Myopia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009898:Optic Disk / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D015594:Optic Disk Drusen / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D009901:Optic Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D012160:Retina / Q000473:pathology / Q000503:physiopathology*; D012161:Retinal Artery / Q000473:pathology / Q000503:physiopathology*; D012166:Retinal Hemorrhage / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D012590:Sclera / Q000473:pathology / Q000503:physiopathology; D012737:Sex Factors; D014822:Vitreous Body / Q000473:pathology / Q000503:physiopathology; D044465:White People