Reasons for visits to an emergency center and hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage.

PURPOSE: To evaluate causes of visits to the Eye Emergency Department, determine the prevalence of subconjunctival hemorrhage (SCH), and assess the role of hemostatic abnormalities among patients with spontaneous recurrent SCH (SRSCH). METHODS: In a prospective study conducted over 2 years, hemostatic function was studied in a subgroup of 105 consecutive patients (39 male) with SRSCH free of systemic risk factors and in 53 age- and sex-matched healthy controls (HC) (24 male). RESULTS: A total of 10,090 patients (mean age 57.2 ± 16.7 years, range 0-94, median 58.4) were evaluated. A total of 39.3% had ocular trauma, 34.9% inflammatory ocular surface disorder, 5.7% floaters, 3.3% visual symptoms of neurologic origin, 1.6% uveitis, 1.5% ocular hypertension, 0.8% retinal tear or detachment, 0.7% retinal vascular disease, and 0.5% other causes. A total of 1.6% of the patients were hospitalized. A total of 11.7% of patients had SCH: in 86.7% it was spontaneous, in 13.3% consequent to trauma or to ocular surface disorders. A total of 105 patients had SRSCH, and the prevalence of hemostatic abnormalities among them was not different from HC. Type I von Willebrand disease was diagnosed in 1 patient with SCH and in none of the HC (χ² = 0.13, p = 0.72). CONCLUSIONS: Most patients had ocular infection or trauma and were treated on an outpatient basis; SCH was the third cause of access. The large majority of SCH were unprovoked, and the prevalence of hemostatic alterations in patients with SRSCH and no systemic causes was not different from the general population. Hemostatic screening or second level blood clotting tests were of no use in these patients.

Hemorragia coroidea expulsiva espontánea. Caso clínico / Spontaneous expulsive choroidal hemorrhage. Case report

CASO CLÍNICO: Se presenta el caso de una paciente de 85 años de edad, procedente de un centro geriátrico, que acudió a urgencias con un cuadro de hemorragia ocular masiva aparentemente de forma espontánea en ojo izquierdo (OI). No había constancia de antecedentes oftalmológicos en su historial clínico. La paciente refería haber sido operada de catarata en ambos ojos hacía más de 25 años y llevar varios años sin visión por el OI. DISCUSIÓN: La hemorragia coroidea expulsiva espontánea (HCEE) no quirúrgica es una entidad clínica devastadora muy rara. Los factores predisponentes implicados en su desarrollo incluyen: edad avanzada, enfermedades vasculares (arterioesclerosis sobre todo), glaucoma y daño corneal severo

CLINICAL CASE: A case is presented of an 85-year-old woman living in a geriatric residence, who was admitted to the emergency department of our hospital with a spontaneous expulsive choroidal hemorrhage in her left eye. There was no a history of ophthalmic disease, and the patient only reported having intracapsular cataract surgery in both eyes 25 years ago, and that she also became blind in her left eye in the past few years. DISCUSSION: Non-surgical spontaneous expulsive choroidal hemorrhage is a very rare and disastrous clinical event. The predisposing factors involved are: advancing age, vascular illness (especially atherosclerosis), glaucoma, and severe corneal damage

D-dimer evaluation of hemorrhagic orbital lymphangioma.

An 8-year-old boy with recurrent acute bleeding of lymphangioma of the left orbit is described. D-dimer levels increased as the size of the mass became stable, showing the effect of fibrinolysis within the hemorrhagic mass after clotting. D-dimer levels confirmed the possible use of conservative management of this lymphangioma.

Thrombocytopenia and the risks of intraocular surgery.

BACKGROUND AND OBJECTIVE: In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery. PATIENTS AND METHODS: A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994--1995 and 1998--1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study. RESULTS: Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail. CONCLUSIONS: The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia.

[New class of drugs for treatment of eye vascular diseases]. / Novyi klass lekarstvennykh veshchestv v lechenii sosudistoi patologii glaz]

Hemolytic ocular film (HOF) represents a polymer-based "puff pastry" whose external layers contain antioxidant emoxipine and the internal layer contains an immobilized thrombolytic enzyme; such a structure ensures a successive multifunctional effect on the main components of pathogenesis: lipid peroxidation, local hemostasis, fibrinolysis, and immune system of patients with vascular abnormalities of the eyes. The drug was used in the treatment of 248 patients with intraocular hemorrhages of traumatic origin. Control group (150 patients with the same condition) was treated traditionally. Application of HOF resulted in complete or almost complete lysis of the blood in 95% of patients; in 5% the effect was null. Traditional therapy helped attain complete lysis of the blood in 9% and partial in 43% of patient; in 48% of patients the effect was null.