Retinal hemorrhages in the newborn.

There were 100 babies examined within 24 hours of birth. Retinal hemorrhages were found in 35% of newborns. Birth trauma from forceps delivery and prolonged labor were thought to be significant. Babies born by cesarean section were less likely to have retinal hemorrhages. Asphyxia was also found to be significant. The role of low plasma prothrombin levels, the vacuum extractor and increased intracranial pressure were discussed as etiologic agents. According to Von Noorden in 1973 there appears to be no positive correlation between hemorrhage of the macula and the occurrence of strabismus.     

Retinal hemorrhages in meningococcal septicemia.

PURPOSE: Meningococcal septicemia is associated with coagulopathy and hemorrhagic tendency. We carried out this study to determine the incidence of retinal hemorrhages in meningococcal septicemia. METHODS: This was a prospective study involving all children admitted to the Sheffield Children's Hospital, Sheffield, England, with a diagnosis of meningococcal septicemia. Confirmation of meningococcal infection was by blood culture or DNA analysis using polymerase chain reaction. The children underwent ocular examination including dilated fundus examination by direct and indirect ophthalmoscopy. Details of their coagulation status were also obtained. RESULTS: Twelve children (mean age, 4.5 years) with a confirmed diagnosis of meningococcal septicemia were included. All children had coagulopathy. Retinal hemorrhages were found in 5 children (42%). The disease was fatal in 3 children. Group C meningococcus was responsible for the infection in all those with retinal hemorrhages and those with fatal outcome. CONCLUSIONS: Retinal hemorrhage is a common feature in meningococcal septicemia. Ophthalmic evaluation should be part of the assessment of children with meningococcal septicemia. Future studies on meningococcal disease should include retinal hemorrhage as another parameter in the assessment. This should help us to understand the role of retinal hemorrhage in the prognosis of this serious disease.     

Retinal hemorrhages in anastrozole users.

PURPOSE: To determine whether women using anastrozole (an aromatase inhibitor, which suppresses estrogen synthesis) are likely to have retinal hemorrhages. METHODS: Fundus photographs were obtained for a study comparing effects on vision and the eye of anastrozole (1 mg/d) and tamoxifen (20 mg/d) for women receiving adjuvant endocrine therapy for early-stage breast cancer. Photographs (2 eyes per subject) were evaluated for hemorrhages by an ophthalmologist masked from identifying subject information. The presence of hemorrhages was assessed for 35 anastrozole users, 38 amenorrheic tamoxifen users, and 53 amenorrheic (peri- or postmenopausal) control subjects not using any endocrine medication. The age range was 43 to 69 years; only subjects reporting normal vision and healthy eyes were recruited. Photographs from 36 tamoxifen users from a previous study also were assessed. Views of the fundus extended appreciably beyond the posterior pole for all tamoxifen and anastrozole users, and for 38 of the control subjects. Photographic assessments were compared with medical history and blood pressure data, and optical coherence tomography was used for quantifying aspects of foveal shape that might be affected by vitreoretinal traction. RESULTS: Four anastrozole users and no contemporaneous tamoxifen users but one previously tested tamoxifen user had retinal hemorrhages, in each case within the posterior pole. Two anastrozole users had a flame hemorrhage (in the retinal nerve fiber layer), and two had a blot hemorrhage (deeper in the retina). No control subjects were observed to have hemorrhages. CONCLUSIONS: Anastrozole use appears to be associated with an increased prevalence of retinal hemorrhages. The hemorrhages may mark systemic vascular compromise resulting from estrogen depletion, and/or they may be consequences of vitreoretinal traction resulting from estrogen depletion. They may also depend on the use of medications for controlling common anastrozole-induced side effects. Prospective studies need to be conducted with larger numbers of subjects.     

Retinal hemorrhages in malignant arterial hypertension

We conducted a detailed investigation into retinal hemorrhages in renovascular malignant arterial hypertension experimentally produced in rhesus monkeys. The hypertension was produced by modified Goldblatt's procedures in 60 rhesus monkeys and hypertensive fundus changes were studied by ophthalmoscopy, stereoscopic color fundus photography and fluorescein fundus angiography. Our study revealed that, in hypertensive retinopathy due to malignant hypertension, retinal hemorrhages usually did not constitute either one of the earliest or one of the most conspicuous retinal lesions, but, on the contrary, were a minor feature of the retinopathy. Neither the time of onset of retinal hemorrhages nor their peak severity showed any significant correlation with the level of the arterial hypertension. The hemorrhages were usually situated in the nerve fiber layer, and could be located anywhere in the fundus but were usually found in the distribution of the radial peripapillary retinal capillaries. There was no association between the presence of retinal hemorrhages and retinal venous changes; the latter were seen only in a minority of animals and consisted of retinal venous stasis, venous collaterals and arteriovenous shunts.     

Retinal hemorrhages in posterior vitreous detachment.

Detachment of the posterior vitreous can cause clinically significant retinal hemorrhage. Two patients with acute posterior vitreous detachment had massive retinal hemorrhages overlying the optic disks. These absorbed in time without sequealae. A third patient had numerous small blot hemorrhages scattered near the optic disk and macula. A fourth patient presented with a small macular hemorrhage causing temporary visual loss. All patients had moderately severe myopia and were in good health without hypertension or diabetes. There was no history of trauma or Valsalva maneuver. Hematologic and coagulation studies were normal. These cases indicate that retinal hemorrhages due to posterior vitreous detachment may be strikingly large, multiple, and, when involving the macula, cause temporary visual loss.