University of Iowa Health Care

Ophthalmology and Visual Sciences

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Intrapapillary Hemorrhage

Posted December 20, 2019

Contributor: Heather A. Stiff, MD; David A. Ramirez, MD; Nathaniel C. Sears, MD

Photographer: Antoinette Venckus

Category(ies):

  • Glaucoma
  • Neuro-ophthalmology

A 62-year-old female with primary open angle glaucoma was seen in the glaucoma clinic for follow-up and was incidentally found to have an intrapapillary hemorrhage in her right eye as shown below (figure 1). Intrapapillary hemorrhages are more common near the nasal border of the nerve in myopic eyes with tilted discs, and may be spontaneous or precipitated by acute disc edema, valsalva maneuver, or vitreopapillary traction [1]. The patient in this scenario was not myopic, and underwent echography to rule our optic nerve drusen or a vascular tumor. It was later revealed that she had been coughing recently, possible leading to a valsalva maneuver.  These hemorrhages generally have a good prognosis and resolve spontaneously [1,2]. Of note, this hemorrhage is different than the typical peripapillary hemorrhage seen in normal tension glaucoma, which is located on the border of the border of the optic disc (see Optic Disc Hemorrhage in Normal Tension Glaucoma).

Color fundus photography of the right eye shows an intrapapillary hemorrhage of the superior portion of the optic nerve extending from 11:30-1:00 with adjacent hyperemia of the optic disc.

Figure 1. Color fundus photography of the right eye shows an intrapapillary hemorrhage of the superior portion of the optic nerve extending from 11:30-1:00 with adjacent hyperemia of the optic disc.

Reference(s)

  1. Kokame GT, Yamamoto I, Kishi S, Tamura A, Drouilhet JH. Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage. Ophthalmology 2004;111(5):926-930.  https://PubMed.gov/15121370. DOI: 10.1016/j.ophtha.2003.08.040
  2. Moon IH, Lee SC, Kim M. Intrapapillary hemorrhage with concurrent peripapillary and vitreous hemorrhage in two healthy young patients. BMC Ophthalmol 2018;18(1):172.  https://PubMed.gov/30005697. DOI: 10.1186/s12886-018-0833-z
last updated: 12/20/2019
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