What are the causes of retinal hemorrhage?

From the Guidelines

Retinal hemorrhage is primarily caused by retinal vein occlusion (RVO), which occurs when there is a partial or complete obstruction of a retinal vein.

Causes of Retinal Hemorrhage

• Retinal vein occlusion (RVO): RVO is the second most common retinal vascular disorder following diabetic retinopathy and is often associated with vision loss 1.
• Systemic arterial hypertension: Hypertension is a major risk factor for RVO, with 48% of RVO cases attributed to hypertension 1.
• Arteriosclerosis: Arteriosclerosis is another significant risk factor for RVO, particularly in older adults 1.
• Diabetes: Diabetes is also a major risk factor for RVO, with 5% of RVO cases attributed to diabetes 1.
• Age: Older age, particularly over 40 years, is a significant risk factor for RVO, with the most common age range being from the 6th to the 7th decade 1.

Mechanism of Retinal Hemorrhage

The obstruction of a retinal vein leads to a decrease in venous outflow, resulting in retinal vascular leakage and an increase in intravenous pressure, which causes intraretinal hemorrhages 1.

Types of Retinal Vein Occlusion

• Central retinal vein occlusion (CRVO): Occurs when there is an obstruction of the retinal vein at or posterior to the optic nerve head 1.
• Branch retinal vein occlusion (BRVO): Occurs when there is a complete or partial obstruction at a branch or tributary of the central retinal vein 1.
• Hemiretinal vein occlusion (HRVO): Occurs when there is an occlusion at the disc that commonly involves half of the neurosensory retinal venous drainage 1.

From the Research

Causes of Retinal Hemorrhage

The causes of retinal hemorrhage can be varied and include:

• Abusive head trauma (AHT) resulting from acceleration-deceleration injury with or without blunt impact 2
• Cardiopulmonary resuscitation 3
• Accidental trauma 3
• Blood dyscrasias and infections 3
• Subarachnoid hemorrhage 4
• Arteriovenous malformation 4
• Birth trauma 4
• Leukemia 4
• Endocarditis 4
• Cerebral sinovenous thrombosis (CSVT) 5
• Meningitis 5
• Mastoiditis 5
• Hypercoagulability 5
• Raised intracranial pressure 5
• Sepsis 5

Differential Diagnosis

It is essential to consider the differential diagnosis of retinal hemorrhage in young children, including:

• Retinal hemorrhage patterns, severity, and frequencies 6
• Ocular or systemic signs 6
• Laboratory and imaging tests 6
• Coagulopathy, which may accompany AHT but does not rule out the possibility of abuse 2