This patient developed sudden vision loss in their left eye while on the toilet.
A large sub-internal limiting membrane (ILM) hemorrhage occupies the macula, while a large subhyaloid hemorrhage extends from the nerve nasally. Scattered retinal hemorrhages are also seen.
Blood pressure was 191/141, and they were sent to the emergency room for hypertensive control.
When examined 3 days later, the macular blood had already begun to decrease. OCT scanning shows marked hyperreflectivity from the blood with posterior shadowing.
The blood gradually resolved over the next four months, and vision improved to 20/30.
Learning Points:
Acute sub-internal limiting membrane (ILM) hemorrhage most commonly is a result of a Valsalva maneuver or trauma, but can also happen spontaneously, as with anemia. The presence of subhyaloid hemorrhage, as well as the association with severe hypertension as occurred in our patient, is quite unusual.
