Introduction

• Hemorrhage within anterior segment.
• May or may not be accompanied by posterior segment hemorrhage.
• Cause: multiple etiologies, may be primary ocular damage or result of underlying coagulopathy.
• Signs: blood in anterior chamber, may be diffuse or form discrete clot. If unclotted, may collect ventrally and form fluid line.
• Diagnosis: examination. Underlying condition may need further investigation.
• Treatment: aimed at controlling intraocular pressure, preventing posterior synechiae/iris bombe and/or secondary glaucoma. Underlying condition should be determined and treated appropriately.
• Prognosis: variable, depending on etiology. Loss of eye possible.

Pathogenesis

Pathophysiology

• Hemorrhage occurs when blood vessels from uveal tract are damaged, disrupted or anomalous.
• Iris vessels most common source, but retinal, choroidal and ciliary vessels are possible.

• Disruption of uveal tract vessels results in blood leaking into ocular media (aqueous, vitreous).
• Anterior uveal tract → anterior segment hemorrhage, possibly some escape into posterior segment through suspensory ligament.
• Etiology may influence whether clot forms in anterior chamber.
  • Uveitis/trauma: blood usually clots.
  • Blood dyscrasias/coumarin intoxication: usually unclotted, may be diffuse (acutely) or form fluid line (as it resorbs).
  • Neoplasia/congenital anomalies/hypertension: usually recurrent - may or may not clot.
• Unclotted blood and degradation products may block iridocorneal angle (ICA), reducing aqueous outflow → increase in intraocular pressure → glaucoma if not treated.
• Always accompanied by uveitis Uveitis , so danger of posterior synechiae formation (adhesions between posterior iris and anterior lens) → iris bombe (360° synechiae) → no aqueous exit through pupil, iris root pushed forward blocking ICA → peripheral anterior synechiae (adhesions between iris root and corneoscleral region) → glaucoma.

Timecourse

• Following single bleeding episode, resorption occurs within 7-14 days.
• Acute onset.

Diagnosis

Treatment

Outcomes