Optic Disc Hemorrhage

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Disc hemorrhages are characteristic linear hemorrhages perpendicular to the optic disc, most commonly on the superotemporal or inferotemporal margin. Although the cause of disc hemorrhages has not been fully characterized, mechanical and vascular hypotheses with evidence supporting both have been proposed. Although disc hemorrhages can occur in eyes with no signs of glaucoma, in glaucomatous eyes, disc hemorrhages are a risk factor for progression. Disc hemorrhages themselves cannot be treated but their presence may warrant intensification of intraocular pressure lowering therapy. The purpose of this article is to provide a review of disc hemorrhage for the trainee or practicing ophthalmologist.

Disease Entity

Disc hemorrhage. Alternate names: optic disc hemorrhage, Drance hemorrhage, splinter hemorrhage, nerve fiber layer hemorrhage.

Disease: Disc Hemorrhages

Disc hemorrhages are splinter or flame-shaped hemorrhages oriented perpendicular to the optic disc margin.[1][2][3][4] Classically, these hemorrhages are located in the prelaminar optic disc, cross the peripapillary zone, and extend into the adjacent superficial retinal nerve fiber layer,[1][3][4] although they may not occupy the entire length from disc to retina.[4] Alternately, deeper disc hemorrhages may appear round and blotchy.[3] Less commonly, a disc hemorrhage may be noted in the peripapillary retinal nerve fiber layer reaching within one disc diameter of the optic disc margin.[2]

Etiology and Pathophysiology

Mechanical and Vascular Hypotheses

The Relationship to Rim Notches

Epidemiology

Prevalence

Associations

Ocular

Systemic

Physical Examination and Clinical Diagnosis

Location

Duration and Recurrence

Diagnostic Procedures

Differential diagnosis

Management

Prognosis

Development of Glaucoma

Do all individuals with disc hemorrhage develop glaucoma?

Progression of Glaucoma

Exfoliation Glaucoma

Recurrent Disc Hemorrhages

Future Work

References

  1. 1.0 1.1 Uhler TA, Piltz-Seymour J. Optic disc hemorrhages in glaucoma and ocular hypertension: implications and recommendations. Curr Opin Ophthalmol. 2008;19(2):89–94.
  2. 2.0 2.1 Schacknow PN, Samples JR eds. The glaucoma book: a practical, evidence-based approach to patient care. New York: Springer; 2010.
  3. 3.0 3.1 3.2 Drance SM. Disc hemorrhages in the glaucomas. Surv Ophthalmol. 1989;33(5):331–337.
  4. 4.0 4.1 4.2 Budenz DL, Anderson DR, Feuer WJ, et al. Detection and prognostic significance of optic disc hemorrhages during the Ocular Hypertension Treatment Study. Ophthalmology. 2006;113(12):2137–2143.