Suprachoroidal hemorrhage is an ophthalmic emergency involving bleeding within the suprachoroidal space of the eye. This condition can lead to severe visual impairment if not promptly addressed.
What is Suprachoroidal Hemorrhage
Suprachoroidal hemorrhage (SCH) involves bleeding into the suprachoroidal space, a potential space between the choroid and the sclera, the outer white layer of the eye. The choroid is a vascular layer nourishing the outer retina. During a hemorrhage, blood from ciliary arteries or vortex veins fills this space. This accumulation can displace the choroid and retina, sometimes causing “kissing choroidals” in severe cases.
Unlike serous choroidal detachment, which involves fluid, SCH is characterized by blood accumulation. This leads to a sudden increase in intraocular pressure, which can compromise the eye’s internal structures and cause significant vision loss. SCH is classified as “expulsive” if it occurs acutely during surgery with severe symptoms, or “delayed” if it develops post-surgery and is less severe.
Why Suprachoroidal Hemorrhage Occurs
Suprachoroidal hemorrhage often arises as a complication during or immediately after intraocular surgeries, such as cataract surgery, glaucoma surgery, vitrectomy, and penetrating keratoplasty. A primary trigger is a sudden drop in intraocular pressure (hypotony) during or after surgery, which can rupture ciliary arteries. The incidence after cataract surgery ranges from 0.03% to 0.1%, and 1.6% to 6.1% for glaucoma surgery.
Several systemic medical conditions increase SCH risk, including advanced age, uncontrolled hypertension, atherosclerosis, and diabetes mellitus. Anticoagulant or antiplatelet medications also elevate bleeding risk. Ocular risk factors include high myopia, glaucoma, aphakia, previous ocular trauma, and prior intraocular surgeries.
Severe eye trauma can directly cause SCH by damaging blood vessels. Rare spontaneous cases can also occur without clear surgical or traumatic triggers, sometimes linked to underlying systemic conditions or fragile choroidal vasculature.
Identifying Suprachoroidal Hemorrhage
Patients experiencing suprachoroidal hemorrhage typically report acute, severe eye pain, often accompanied by sudden and significant vision loss. Other common symptoms include headache, nausea, and vomiting. The affected eye may also show signs of redness and swelling.
Ophthalmologists use several diagnostic methods to confirm SCH. Ophthalmoscopy may reveal a dark, rounded choroidal elevation. Ultrasound B-scan is a primary tool, visualizing the hemorrhage as a dome-shaped or convex elevation in the suprachoroidal space. This imaging helps determine the bleeding’s size, location, extent, and the retina and vitreous status. For trauma cases, a CT scan may further assess the injury.
Treating Suprachoroidal Hemorrhage
Initial management of suprachoroidal hemorrhage involves medical strategies to control symptoms and prevent complications. Pain is managed with topical cycloplegics like atropine and oral analgesics. Anti-inflammatory medications, including topical or oral steroids, reduce inflammation and promote blood clot liquefaction. Intraocular pressure is managed with antiglaucoma medications to prevent further bleeding and protect ocular structures.
Surgical intervention is necessary if the hemorrhage is large, persistent, or causes complications like retinal detachment or appositional choroidals. The common procedure involves draining blood from the suprachoroidal space via a sclerotomy, a small incision in the sclera. Drainage is often delayed for one to two weeks to allow blood liquefaction. In some cases, drainage may combine with vitrectomy, especially if retinal or vitreous hemorrhage is present. The treatment goal is to relieve pressure, preserve vision, and prevent irreversible eye damage.
After a Suprachoroidal Hemorrhage
Recovery following a suprachoroidal hemorrhage can be prolonged, requiring close follow-up with an ophthalmologist. Visual outcome varies considerably, depending on the hemorrhage’s size, location, type, and treatment promptness and effectiveness. While some vision loss is common, significant visual recovery is possible for many patients.
Potential complications include elevated intraocular pressure, recurrent bleeding, retinal detachment, and in severe cases, phthisis bulbi (a shrunken, non-functional eye). Eyes with retinal incarceration may experience severe vision loss. Ongoing ophthalmic care is important to monitor for complications and manage residual issues, aiming to maximize preserved vision and overall eye health.