This 40YO male presented with sudden vision loss in his left eye. Vision was 20/200 OS and 20/20 in his normal right eye.
Fundus photo shows a large subhyaloid hemorrhage covering the macula, vitreous hemorrhage extending inferiorly, and some scattered deep retinal hemorrhages. Fluorescein angiography shows no leakage or source for the blood.
Blood pressure was 235/128. He was immediately sent to the ER for further management.
One week later, vision spontaneously improved to 20/30, the subhyaloid hemorrhage almost completely resolved, and the deep retinal hemorrhages were fading.
Learning Points:
The subhyaloid blood and deep retinal hemorrhages, along with the unilateral presentation, are all quite unusual for hypertensive retinopathy. We are not sure if these hemorrhages were related to his hypertension, but thankfully, they are resolving now that his blood pressure has normalized.
