A flame hemorrhage is a distinct form of bleeding in the retina, the light-sensitive tissue at the back of the eye. It often signals underlying medical issues that require attention. This particular type of hemorrhage has a characteristic appearance that helps eye care professionals identify it.
What is a Flame Hemorrhage?
A flame hemorrhage is a type of bleeding in the retina, named for its distinctive shape. These hemorrhages appear as bright red, linear streaks that resemble a flame or splinter. Their unique form is due to their location within the nerve fiber layer of the retina. The nerve fiber layer contains bundles of nerve axons arranged horizontally, which restricts the spread of blood to a linear pattern.
When blood leaks from tiny capillaries in this layer, it spreads along these nerve fibers, creating the elongated, feathery appearance. This differentiates flame hemorrhages from other retinal bleeding types, such as dot-and-blot hemorrhages, which occur in deeper retinal layers. The presence of these hemorrhages indicates a disruption in the retinal microvasculature.
Common Causes of Retinal Hemorrhages
Flame hemorrhages are frequently associated with systemic health conditions affecting blood vessels. Uncontrolled high blood pressure (hypertension) is a common cause, as elevated pressure can damage retinal blood vessels, leading to rupture. Diabetic retinopathy, a complication of diabetes, also frequently causes these hemorrhages; high blood sugar levels can damage retinal blood vessels, making them prone to leakage.
Retinal vein occlusions, where a retinal vein becomes blocked, can also lead to flame hemorrhages due to increased pressure and leakage. Other ocular conditions, such as severe acute glaucoma (dangerously high eye pressure), may sometimes contribute. Additionally, eye trauma or sudden increases in intracranial pressure can cause these hemorrhages.
Symptoms and Diagnosis
Symptoms of a flame hemorrhage vary depending on its size and location within the retina. Small hemorrhages, especially those away from central vision, may cause no noticeable symptoms and are often discovered incidentally during a routine eye examination. Larger or centrally located hemorrhages, however, can lead to visual disturbances.
Individuals might report blurred vision, dark spots or “floaters” in their visual field, or distinct blind spots. Vision loss can occur if the hemorrhage affects the macula, the part of the retina responsible for sharp, central vision. Diagnosis primarily involves a dilated eye exam, where an ophthalmologist visualizes the retina. Further assessment might involve Optical Coherence Tomography (OCT) to evaluate retinal layers or fluorescein angiography to visualize blood vessel integrity and leakage patterns.
Treatment Approaches and Outlook
Managing flame hemorrhages primarily involves addressing the underlying medical condition. For example, if uncontrolled hypertension is the cause, strict management of blood pressure through medication and lifestyle changes is important. Similarly, for individuals with diabetes, tight control of blood sugar levels is a primary focus to prevent further retinal damage.
In many cases, the flame hemorrhage may resolve spontaneously over several weeks to months as the blood is reabsorbed by the body, often without specific intervention. However, if the hemorrhages are part of a broader condition like proliferative diabetic retinopathy or a severe retinal vein occlusion, specific eye treatments such as laser photocoagulation or intravitreal injections may be necessary to stabilize the retina and prevent further vision loss. The outlook generally depends on the severity of the underlying cause and how well it is managed, with regular eye exams remaining important for monitoring retinal health.