Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease

Abstract

Expulsive suprachoroidal hemorrhage can be surgical or spontaneous. Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare entity. Most of the reported cases of SESCH were caused by a combination of corneal pathology and glaucoma. We are reporting a rare presentation of SESCH with no pre-existing glaucoma or corneal pathology and caused by massive intra- and peri-ocular hemorrhage due to decompensated liver disease.

Spontaneous suprachoroidal hemorrhage: Case report and review of the literature

“…Following the occurrence of SSCH, bullous hemorrhagic choroidal detachment displaces the vitreous and moves the lens–iris diaphragm forward, resulting in secondary angle closure glaucoma, 20 which was noted in most of the events (87.5%), and even subsequent global rupture was noted. 5 22 31 In the absence of hyphema, such glaucoma may be diagnosed as a pupillary block and be mistreated with pilocarpine, as in our case. Due to a mass effect, SSCH-associated glaucoma is rarely responsive to medication and peripheral iridotomy.…”

“…Advanced age over 60 years is a well-known predisposing factor for suprachoroidal hemorrhage. 3 4 5 Not surprisingly, most (14/16 cases) of the patients with AMD were older than this. In the case of patients aged over 60 years (24 eyes of 23 cases), the most common risk factor has been shown to be abnormal coagulopathy (19/23, 82.6%), including use of anticoagulants (16/23, 69.6%) due to cardiovascular or cerebrovascular diseases (15/23, 65.2%), followed by hypertension (14/23, 60.9%).…”

“…A total of 23 articles written since 2001 were reviewed and were meta-analyzed according to the clinical course, risk factors, diagnostic tools, management, and final outcomes. 5 6 8 9 10 16 17 18 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 …”

“…In the case of patients aged over 60 years (24 eyes of 23 cases), the most common risk factor has been shown to be abnormal coagulopathy (19/23, 82.6%), including use of anticoagulants (16/23, 69.6%) due to cardiovascular or cerebrovascular diseases (15/23, 65.2%), followed by hypertension (14/23, 60.9%). However, among eight patients (25.8%) younger than 60 years, 5 10 26 28 29 31 34 five cases (62.5%) had hypertension and five cases (62.5%) had DM [of them, PDR and taking anticoagulants in 2 cases (37.5%) and AMD in another 2 cases (37.5%)].…”

“…1 2 In extremely rare circumstances, spontaneous suprachoroidal hemorrhage (SSCH) occurs and presents with sudden-onset sight loss and acute angle-closure glaucoma. The associated systemic factors include old age, 3 4 5 anticoagulant or thrombolytic therapy, 6 7 8 9 10 systemic hypertension (HTN), 11 12 13 14 atherosclerosis, 3 15 diabetes mellitus (DM), 10 blood dyscrasia, 5 16 17 chronic renal disease, 9 15 18 and the Valsalva maneuver. 19 The associated ocular factors are age-related macular degeneration (AMD), 6 20 21 glaucoma, 20 22 and high myopia.…”