Terson Syndrome is a medical condition affecting the eye, characterized by bleeding within the eye’s structures, typically following a sudden increase in pressure within the skull. This intraocular hemorrhage can impact vision.
What is Terson Syndrome?
Terson Syndrome involves bleeding into various spaces within the eye, including the vitreous humor, the subhyaloid space, or the retina itself. The vitreous humor is a clear, gel-like substance that fills the space between the lens and the retina. The retina is the light-sensitive tissue at the back of the eye, and the subhyaloid space is located between the vitreous and the retina.
This bleeding occurs secondary to an acute intracranial hemorrhage, which is bleeding within the skull. A sudden elevation in intracranial pressure transmits to the eye, leading to the rupture of delicate retinal blood vessels and characteristic hemorrhages.
Causes and Risk Factors
The primary cause of Terson Syndrome is a subarachnoid hemorrhage (SAH), which is bleeding into the space surrounding the brain. This type of hemorrhage is frequently due to a ruptured cerebral aneurysm, a weakened and bulging blood vessel in the brain. The sudden rise in intracranial pressure associated with SAH transmits to the eye through the optic nerve sheath, causing the intraocular bleeding.
Other causes of intracranial hemorrhage can also lead to Terson Syndrome. These include traumatic brain injury, bleeding within the brain tissue (intracerebral hemorrhage), or bleeding between the brain and its outer membrane (subdural hematoma). Factors that increase the likelihood of the underlying intracranial hemorrhage, such as uncontrolled high blood pressure or a history of aneurysms, also contribute to the risk of Terson Syndrome.
Signs and Symptoms
Individuals experiencing Terson Syndrome often present with both visual and systemic symptoms. The most prominent visual symptom is a sudden, painless decrease in vision in the affected eye, which can range from blurred vision to complete blindness. Patients may also report seeing floaters, which are small specks or strands that drift across their field of vision, or dark spots.
These visual changes typically occur alongside or after systemic symptoms related to the intracranial hemorrhage. Systemic symptoms can include a severe headache, often described as the “worst headache of their life,” accompanied by nausea and vomiting. A stiff neck or altered consciousness are also common indicators of an underlying brain bleed. These neurological signs often precede the onset of visual disturbances.
Diagnosis and Treatment Options
Diagnosing Terson Syndrome begins with a comprehensive eye examination. A fundoscopic examination is the primary diagnostic method, allowing the doctor to visualize retinal and vitreous hemorrhages. If the view of the retina is obscured by dense hemorrhage, an ultrasound (B-scan) of the eye may be used to confirm the presence and extent of the vitreous hemorrhage. Optical coherence tomography (OCT) can provide detailed images of the retinal layers, helping to identify the specific location of the bleeding.
Treatment approaches for Terson Syndrome prioritize managing the underlying intracranial hemorrhage, as this is important for the patient’s overall health. For the eye, initial management involves observation, as many intraocular hemorrhages may resolve spontaneously. However, if the hemorrhage is persistent or causes severe vision loss, surgical intervention may be necessary. A vitrectomy, which involves surgically removing blood from the vitreous humor, is a common procedure performed to restore vision. This surgery is considered if the hemorrhage does not clear within a few months, often around 3 to 6 months, to prevent long-term complications.
Prognosis and Potential Complications
The prognosis for visual recovery in Terson Syndrome is favorable, especially with timely diagnosis and appropriate treatment. When surgical intervention like vitrectomy is performed for persistent or severe vision loss, visual outcomes can be excellent. However, the overall prognosis also depends on the severity of the underlying intracranial hemorrhage and its neurological impact.
If left untreated, Terson Syndrome can lead to several potential complications that may result in permanent vision impairment. These complications include the development of glaucoma, a condition characterized by increased pressure within the eye that can damage the optic nerve. Retinal detachment, where the light-sensitive tissue at the back of the eye pulls away from its supporting layers, is another possible complication. Additionally, epiretinal membrane formation, which is the growth of a thin, scar-like tissue over the retina, can distort vision. Addressing the underlying intracranial hemorrhage is essential not only for visual recovery but also for the patient’s overall survival and long-term well-being.