What are the causes of retinal hemorrhage in a young patient?

From the Guidelines

Retinal hemorrhage in a young patient is most likely caused by hypertension, vascular disorders, or systemic diseases.

Causes of Retinal Hemorrhage

• Hypertension: High blood pressure can cause damage to the retinal blood vessels, leading to hemorrhages 1.
• Vascular disorders: Conditions such as retinal vein occlusion (RVO) can cause retinal hemorrhages due to obstruction of the retinal vein 1.
• Systemic diseases: Certain diseases, such as Fabry disease, can cause vascular involvement of the retina, leading to retinal hemorrhages 1.

Risk Factors

• Systemic arterial hypertension: A major risk factor for RVO and retinal hemorrhage 1.
• Arteriosclerosis: A risk factor for RVO and retinal hemorrhage 1.
• Diabetes: A risk factor for RVO and retinal hemorrhage 1. It is essential to note that retinal vein occlusions are relatively uncommon in individuals under 40 years of age 1. Therefore, in young patients, other causes of retinal hemorrhage, such as hypertension or systemic diseases, should be considered.

From the Research

Causes of Retinal Hemorrhage in Young Patients

The causes of retinal hemorrhage in young patients can be varied and include:

• Abusive head trauma (AHT) 2, 3, 4, 5
• Accidental head injury 2, 3, 5
• Birth trauma 2, 6
• Subarachnoid hemorrhage 3
• Bleeding disorders such as coagulopathy, vitamin K deficiency, platelet function abnormalities, thrombocytopenia, disseminated intravascular coagulation (DIC), and trauma-induced coagulopathy (TIC) 4
• Arteriovenous malformation 3
• Other medical conditions such as leukemia and infections like endocarditis 3

Characteristics of Retinal Hemorrhages

The characteristics of retinal hemorrhages can help distinguish between different causes, including:

• Location and distribution of hemorrhages, with AHT typically causing severe, multilayered hemorrhages extending to the periphery of the retina 2, 5
• Presence of retinoschisis, which is highly specific for AHT 2, 4
• Number and type of hemorrhages, with AHT typically causing a high number of dot-blot (intraretinal) hemorrhages 5
• Depth of hemorrhages, with AHT typically causing deeper layer hemorrhages 5

Diagnostic Considerations

When evaluating a young patient with retinal hemorrhage, it is essential to consider the differential diagnosis and to rule out other potential causes, including:

• Accidental head injury 2, 3, 5
• Medical conditions such as bleeding disorders and infections 3, 4
• Birth trauma 2, 6
• A thorough history and physical examination, as well as imaging studies and laboratory tests, may be necessary to determine the underlying cause of the retinal hemorrhage 2, 3, 4, 5