There was no impact, but there was bleeding in the retina? What caused it?

Retinal hemorrhage is a serious condition that occurs when blood leaks into the layer of light-sensitive tissue in the eye called the retina. This could be a sign of a serious health problem or a symptom of a condition that needs to be treated immediately. The retina is the sensory membrane that lines the inner back surface of the eyeball. The retina contains millions of light-sensitive cells called rods and cones, as well as a dense network of tiny blood vessels. Bleeding in the retina generally occurs when these small blood vessels are damaged due to untreated disease.

                 Retinal hemorrhage on fundoscopic examination

What causes bleeding in the retina?

There are several conditions that can cause bleeding in the retina, including:

1. Medical conditions, such as hypertension, diabetes, lupus, anemia, infection, and leukemia. Diabetic retinopathy is a complication of diabetes that causes damage to the blood vessels in the retina, which in turn can cause bleeding. Hypertensive retinopathy is a complication caused by high blood pressure and damage to the blood vessels in the eye, causing bleeding in the retina.

2. Eye diseases, such as macular degeneration and central serous retinopathy. Age-related macular degeneration (AMD or ARMD) affects the central part of the retina, called the macula. The macula is a small area in the center of the retina that is responsible for our sharpest vision. Central serous retinopathy is a condition involving the formation of fluid sacs under the outer layer of the retina, which can cause bleeding if the fluid sacs rupture.

3. Head injury caused by accident.

4. Shaken baby syndrome or other forms of child abuse.

5. Sudden changes in air pressure during activities such as mountain climbing or diving. Changes in air pressure can reduce the amount of oxygen available to the retina.

6. Some medications, such as blood thinners.

7. On very rare occasions, pushing due to constipation, severe coughing, or vomiting.

Symptoms of Retinal Hemorrhage

Symptoms of hemorrhage in the retina can vary depending on how severe the condition is. Some common symptoms include:

1. Blurry or blurred vision: Bleeding in the retina can cause vision to become blurry.

2. Shadows or “spots” in vision: Patients may see dark shadows or spots in their field of vision.

3. Decreased visual acuity: Vision may decrease gradually or suddenly.

4. Sensation of flashes of light: Some people may experience the sensation of flashes of light in their eyes.

What are the types of hemorrhages in the retina? The shape, location, and severity of retinal hemorrhage can provide clues regarding the type of hemorrhage and its possible origin and cause. The following are the main types of retinal hemorrhages:

1. Vitreous and preretinal hemorrhage: blood diffuses through the vitreous membrane of the eye and can collect at the bottom of the eye as it settles. Your eye doctor will see this during the examination. The causes can be high blood pressure, trauma, or excessive growth of blood vessels in the retina due to diseases such as diabetes. Sometimes, there is no known cause.

2. Flame-shaped hemorrhage: This type of retinal hemorrhage will appear on eye examination as thin shapes, like feathers, flames, or splinters. Researchers believe that flame-shaped bleeding is linked to arterial-based diseases such as hypertension, blood disorders, and certain anemias.

3. Dot or blot hemorrhages: These hemorrhages are found in the deeper layers of the retina and form round and uniform hemorrhages. Conditions such as diabetes, rare disorders of the eyes or blood vessels, or sickle cell disease can cause this type. 4. Roth spots: Roth spots are a type of bleeding that occurs on the retina with a manifestation in the form of spots. This may indicate underlying diseases such as diabetes, hypertension, leukemia, and endocarditis.

5. Other types of bleeding: Other types of bleeding can be associated with diabetes, hypertension, leukemia, radiation treatments, and other diseases.

How do you diagnose hemorrhage in the retina?

Ophthalmologists are very familiar with the different types of retinal hemorrhages. A dilated eye examination using a tool called a slit lamp can show retinal hemorrhage. Your eye doctor may also use special tools to take pictures of the inside of your eye. In some cases, the dye will be injected into a vein in your hand or arm. The dye will flow into the blood vessels of your retina, so the doctor can take very clear images. An imaging technique called OCT also helps eye doctors see retinal hemorrhages better. Your eye doctor will take a thorough history, asking about trauma, injuries, medications, flashes or floaters, and activities such as scuba diving or climbing at high altitudes. They will also ask about any underlying illnesses or conditions you have. The specialist may also ask you to have blood tests or other diagnostic procedures to find out whether you have an underlying disease, such as diabetes, hypertension, infection, or blood vessel disorders, that may be causing retinal hemorrhage. Your eye doctor will work closely with your primary care doctor or specialist to help guide treatment.

Treatment of Retinal Hemorrhage Treatment for retinal hemorrhages depends on the severity and cause. In some cases, the bleeding that occurs is small and can be monitored as it heals on its own within a few weeks or months. In some cases, treatment of the underlying condition can help the patient recover and prevent further complications. Some treatment methods that may be used include:

1. Intravitreal injection: In some cases, an ophthalmologist may inject medication directly into the eye to help control bleeding and treat the underlying condition, such as diabetic retinopathy or macular degeneration.

2. Surgery: In some cases, surgery may be necessary to stop bleeding and repair damage to the retina.

3. Laser therapy: Laser therapy can be used to burn or seal leaking blood vessels in the retina.

The importance of regular eye examinations It's important to protect your retina so you can enjoy good vision for a lifetime. Many problems with the retina can be detected by your eye doctor before you notice symptoms. Comprehensive, routine eye examinations are recommended at least every two years. Your eye doctor will examine your eyes for signs of retinal hemorrhage and other serious retinal problems, so that treatment can begin as soon as possible.

Made by Dr. Raissadita Novdyla

Reviewed by Dr. Karlina Putri Siregar, Sp.