Optical coherence tomographic findings in Terson syndrome

Eric L. Crowell, MD, MPH and Amde Selassie Shifera, MD, PhD

A 62-year-old man presented with a 5-day history of central scotoma of his left eye. Five days prior to presentation he hit his head against the bottom of a trailer. Approximately 30 minutes after the accident he noticed a dark grayish spot in the center of his vision. He also reported that when looks at a light source the light would look reddish. The patient also reported having a generalized headache of a moderate degree that lasted for 15 minutes after the accident.

At presentation, his visual acuity in the left eye was counting fingers at 3 feet. On examination he was found to have a layered hemorrhage in the macula of the left eye (Figure 1A). Spectral domain optical coherence tomography (OCT; Spectralis system; Heidelberg Engineering) showed multi-layered hemorrhage in the macula of the left eye. Specifically, the OCT showed sub-internal limiting membrane (ILM) hemorrhage (both clotted and non-clotted), intraretinal hemorrhage and subretinal hemorrhage (Figure 1B to G). Examination of the right eye was non-remarkable. A computed tomography of the head done at presentation did not show any evidence of intracranial hemorrhage. No intervention was done at the initial presentation.

When the patient returned for follow-up one month later, his vision remained counting fingers (at 2 feet). OCT scan of the left eye showed resolution of the sub-ILM hemorrhage; the subretinal hemorrhage was largely resolved but the patient was still having intraretinal hemorrhage which appeared increased in amount (Figure 2A and B). The patient elected observation; however, he did not return for further follow-up. Even though computed tomography of the head was negative, the history and ocular findings are consistent with Terson syndrome. The mechanism of Terson syndrome is unknown but is believed to be due to a spike in intracranial pressure and the resultant rupture of retinal vessels.^1-4

REFERENCES

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2.         Biousse V et al. The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol 1998; 125:527-544.

3.         Gress DR, Wintermark M and Gean AD. A case of Terson syndrome and its mechanism of bleeding. J Neuroradiol 2013; 40:312-314.

4.         Kapoor S. Terson syndrome: an often overlooked complication of subarachnoid hemorrhage. World Neurosurg 2014; 81:e4.

Eric L. Crowell, MD, MPH; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (former address)

Amde Selassie Shifera, MD, PhD; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (former address)