UPDATE: Bilateral retinal hemorrhage of unknown etiology | Figure 1

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UPDATE: Bilateral retinal hemorrhage of unknown etiology

After an extensive work up following a presentation for acute large bilateral pre-retinal hemorrhages and early vitreous hemorrhaging that was initially attributed to valsalva, this 58YOWF was diagnosed with leukemia.

Retinal hemorrhages OD have completely resolved, but a large vitreous hemorrhage is now obscuring vision and posterior retinal views OS.

The patient was given the option by her retinal specialist to have a pars-plana vitrectomy (PPV) to clear out the heme. Unknown VA potential after PPV exists since no macular views are obtainable. Pt is considering option with oncologist currently.

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What is the role of the primary care or emergency medicine physician? The patient should be referred to an ophthalmologist urgently (within 24 hours) due to concern for a retinal detachment and/or retinal tear that could progress to a retinal detachment.

What is the role of the ophthalmologist?

• examining the eye with a slit-lamp biomicroscope
• assessing for location, size, and cause of vitreous hemorrhage
• B-scan ultrasonography can help detect vitreous hemorrhage, posterior vitreous detachment, retinal tears, and retinal detachment if a complete view of the retina is obscured.

What is the treatment?

Vitreous hemorrhage may resolve spontaneously in some cases. Treatment is based on the underlying cause.

Anti-vascular endothelial growth factor (anti-VEGF) injections and/or panretinal photocoagulation may be used to treat proliferative diabetic retinopathy. Scleral buckling, pneumatic retinopexy, and/or pars plana vitrectomy may be used to treat retinal detachments.

Review the full case on the Academy website for more details, including links to educational resources on key topics related to the case.