OCT 31, 2008
Glaucoma
Disc hemorrhages can occur in patients with glaucoma and other conditions. In glaucoma patients, disc hemorrhages are markers for a complex vasculopathy that is just beginning to be understood. They are also predictors of progressive glaucomatous disease independent of intraocular pressure (IOP) and other factors. This paper reviews the differential diagnosis of disc hemorrhage, as well as evidence that suggests disc hemorrhages are an important sign in glaucoma. Lastly, it presents new evidence showing primary open-angle glaucoma (POAG) patients with disc hemorrhages have an abnormality in vascular perfusion.
Case Study
A 68-year-old white man with type 2 diabetes mellitus and a family history of glaucoma presents for a routine exam. Snellen acuity is 20/20 in both eyes, and applanation tensions are 16 mm Hg bilaterally. The exam is remarkable for suspicious optic disc cupping and moderate nonproliferative diabetic retinopathy in both eyes without macula edema. In the left eye, there is a subtle flame-shaped hemorrhage in the superior nasal quadrant of the disc (Figure 1A). Red-free fundus photography confirms the presence of this hemorrhage and fails to show nerve fiber layer defects (Figure 1B). Since there are other flame-shaped hemorrhages and microaneurysms located throughout the posterior pole, it is likely that this disc hemorrhage is related to diabetic retinopathy. For this patient, standard automated perimetry was reliable and normal in both eyes.