Retinal haemorrhage

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Retinal hemorrhage
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Retinal hemorrhage (UK English: retinal haemorrhage) is a disorder of the eye in which bleeding occurs in the retina, the light sensitive tissue, located on the back wall of the eye. [1] There are photoreceptor cells in the retina called rods and cones, which transduce light energy into nerve signals that can be processed by the brain to form visual images. [2] Retinal hemorrhage is strongly associated with child abuse in infants and young children [3] 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 (a blockage of a retinal vein), anemia, leukemia or diabetes.

Contents

Signs and symptoms

At the early stage, a retinal hemorrhage may not show any symptom at all.

Some symptoms may include:

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. [4]

In infants, retinal hemorrhages (RH) are highly associated with child abuse. [3] The incidence of RH in abusive head trauma is approximately 85%. [5] [6] 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. [7]

Diagnosis

A retinal hemorrhage is generally diagnosed by using an ophthalmoscope or fundus camera in order to examine the inside of the eye. A fluorescein angiography 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. [8] The fluorescent dye can have dangerous side effects: see Fluorescein

Eye examination 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. [1]

Prevention

It is recommended to consult with ophthalmologist or optometrist as early as possible, particularly for people with vision problems, these include 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. [8]

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. [9] Anti-vascular endothelial growth factor (VEGF) drugs like Avastin and Lucentis have also been shown to repair retinal hemorrhaging in diabetic patients and patients with hemorrhages associated with new vessel growth. [10] [11]

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. [12]

See also

Related Research Articles

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<span class="mw-page-title-main">Diabetic retinopathy</span> Diabetes-induced damage to the retina of the eye

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<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old, generally caused by blunt trauma, vigorous shaking, or a combination of both. SBS is the leading cause of fatal head injuries in children under two, with a risk of death of about 25%. The most common symptoms include retinal bleeds, multiple fractures of the long bones, and subdural hematomas.

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<span class="mw-page-title-main">Retinal detachment</span> Medical condition of the eye

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<span class="mw-page-title-main">Subconjunctival bleeding</span> Bleeding within the whites of the eye

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<span class="mw-page-title-main">Central serous chorioretinopathy</span> Eye disease characterized by leakage of fluid under the retina

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<span class="mw-page-title-main">Intraocular hemorrhage</span> Medical condition

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<span class="mw-page-title-main">Macular telangiectasia</span> Disease of the retina affecting central vision

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<span class="mw-page-title-main">Familial exudative vitreoretinopathy</span> Retinal vascular disease

Familial exudative vitreoretinopathy is a genetic disorder affecting the growth and development of blood vessels in the retina of the eye. This disease can lead to visual impairment and sometimes complete blindness in one or both eyes. FEVR is characterized by incomplete vascularization of the peripheral retina. This can lead to the growth of new blood vessels which are prone to leakage and hemorrhage and can cause retinal folds, tears, and detachments. Treatment involves laser photocoagulation of the avascular portions of the retina to reduce new blood vessel growth and risk of complications including leakage of retinal blood vessels and retinal detachments.

<span class="mw-page-title-main">Vitreous hemorrhage</span> Leakage of blood into the internal fluid of the eye

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<span class="mw-page-title-main">Branch retinal vein occlusion</span> Medical condition

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Non-arteritic anterior ischemic optic neuropathy (NAION) is a medical condition characterized by loss of vision caused by damage to the optic nerve as a result of ischemia, or insufficient blood supply. The key symptom of NAION is optic disc swelling, which typically resolves within 2 months, but often leads to optic atrophy. The likelihood of vision improvement after developing this condition is low.

References

  1. 1 2 "Retinal Hemorrhage - What You Need to Know". Drugs.com. Retrieved 2018-09-13.
  2. Yarfitz S, Hurley JB (May 1994). "Transduction mechanisms of vertebrate and invertebrate photoreceptors". The Journal of Biological Chemistry. 269 (20): 14329–32. doi: 10.1016/S0021-9258(17)36620-6 . PMID   8182033.
  3. 1 2 "Consensus Statement: Abusive Head Trauma in Infants and Young Children". Pediatrics. 142 (2). 2018-08-01. doi: 10.1542/peds.2018-1504 . ISSN   0031-4005. PMID   30061300. S2CID   51878771.
  4. Bosch MM, Barthelmes D, Landau K (December 2012). "High altitude retinal hemorrhages--an update" (PDF). High Altitude Medicine & Biology. 13 (4): 240–4. doi:10.1089/ham.2012.1077. PMID   23270439.
  5. Kivlin, J (July 2000). "Shaken baby syndrome". Ophthalmology. 107 (7): 1246–1254. doi:10.1016/s0161-6420(00)00161-5. ISSN   0161-6420. PMID   10889093.
  6. Morad, Yair; Kim, Yuri M; Armstrong, Derek C; Huyer, Dirk; Mian, Marcellina; Levin, Alex V (September 2002). "Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome". American Journal of Ophthalmology. 134 (3): 354–359. doi:10.1016/s0002-9394(02)01628-8. ISSN   0002-9394. PMID   12208246.
  7. Maguire, S A; Watts, P O; Shaw, A D; Holden, S; Taylor, R H; Watkins, W J; Mann, M K; Tempest, V; Kemp, A M (January 2013). "Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review". Eye. 27 (1): 28–36. doi:10.1038/eye.2012.213. ISSN   0950-222X. PMC   3545381 . PMID   23079748.
  8. 1 2 "Retinal Hemorrhage". TheFreeDictionary.com. Retrieved 2018-09-13.
  9. Sparks KO. "Retinal Bleeding". LARetinaSurgeon.com.
  10. Spaide RF, Fisher YL (March 2006). "Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage". Retina. 26 (3): 275–8. doi:10.1097/00006982-200603000-00004. PMID   16508426. S2CID   8262505.
  11. "Age-Related Macular Degeneration Treatment". WebMD.
  12. Pilyugina S. "Retinal Physician - Ocular Dietary Supplementation — Food For Thought". Retinal Physician. Retrieved 2018-09-13.

Further reading