Ocular Hemorrhages

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Ocular hemorrhages are important not only because they produce visual loss but also because they usually indicate a disorder elsewhere in the body. One can roughly classify them in five main groups: external, vitreous, preretinal, retinal, and choroidal.

Of the external hemorrhages the most common is the subconjunctival hemorrhage, which is usually of no importance and may result from trauma or occur spontaneously. However, it is of great concern to the average patient. In older people subconjunctival hemorrhage suggests vessel weakness and warrants further investigation. A complete examination should be made for evidence of arteriosclerosis of the fundus as well as elsewhere in the body. Large hemorrhages may be caused by blows or falls on the head; these hemorrhages may also result from basal skull fractures with accompanying extravasation of blood along the floor of the orbit. Severe compression of the chest, scurvy, or purpura may also produce extensive hemorrhages. However, this never interferes with sight, and treatment consists of conservative measures such as warm compresses, dionin 2 per cent, or merthiolate ointment (ophthalmic 1:5000). Absorption of the extravasation usually requires about two weeks.

Vitreous hemorrhages of significant size interfere with the vision but are usually painless. They may result from trauma, arteriosclerosis, or inflammation of the retina, or may occur without apparent cause. In massive hemorrhages the light reflex is absent.

There is a severe type of recurring hemorrhage into the vitreous which occurs in adolescence, usually in males, and is known as Eales’ disease. The disease tends to. . .



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