Photos from daily clinic of Tarek Shaarawy Glaucoma guru
✍️ flame shaped linear hemorrhages perpendicular to the optic disc margin
✍️ Disc hemorrhages tend to be small and extend from within the RNFL of the optic disc into the peripapillary region.
✍️ most commonly
✍️ usually related to
☝️ structural damage in NRR
☝️ focal defects of the RNFL
☝️ progressive VF defects
☝️ beta zone peripapillary atrophy (βPPA).
✍️ the mechanism not fully understood but mechanical and vascular mechanisms are reported
☝️ combination of ischemia and structural collapse leads to DH
☝️ an initial ischemic insult could cause a first hemorrhage, which leads to rapid VF damage.
☝️ Ongoing degeneration of neuroretinal tissues and microvascular occlusion at the disc may lead to recurrent DH.
✍️ disc hemorrhages can occur in eyes with no signs of glaucoma( rare in normal eyes ) and in 4 to 7 % of glaucomatous eyes ( repeatable hemorrhage)
✍️ disc hemorrhages is a negative prognostic and risk factor for glaucoma severity and likelihood of severe progression.
✍️ eyes with OH that develop DH are six times more likely to progress to primary open-angle glaucoma than hypertensive eyes without DHs.
✍️ DHs can be very small and may be difficult to detect during a clinical examination that is why
☝️ Fundus examination with disc photography, must be done both carefully and frequently to detect DH
☝️focusing on the temporal half of the disc where there is previous damage (RNFL defect or rim notching ) to minimize the number of overlooked DHs.
✍️ Risk factors for DH
☝️ thinner neuroretinal rim
☝️ notching at the baseline
☝️history of migraine
☝️ female sex
☝️ systemic beta-blockers.
☝️ Overtreatment of HTN and bedtime dosing
✅ Differential diagnosis of Disc hemorrhages :
☝️ vitreous detachment
☝️ diabetic Retinopathy
☝️hyperpigmentation around the disc
✅ Management of Disc hemorrhages :
☝️ Disc hemorrhages themselves cannot be treated
☝️ their presence warrants aggressive intensification of intraocular pressure (IOP) lowering measures in glaucomatous eyes.