Spontaneous suprachoroidal and orbital hemorrhage in an older woman associated with prophylactic antiplatelet therapy: A case report and literature review

Suprachoroidal Hemorrhage

“…Several reports of spontaneous cases were predisposed to bleeding because of systemic antithrombotic therapy in subjects treated with warfarin, heparin, thrombolytic agents, or bleeding tendency [2,22,23,25,[28][29][30][31][32][33][34]. Combining systemic antithrombotic agents with the Valsalva maneuver may further increase the risk of spontaneous SCH [2,23,28,35]. This is especially challenging in patients with mechanical valves who cannot be off warfarin and are prone to ocular bleeding [36].…”

“…Spontaneous SCH mainly presents with severe unilateral ocular pain and headache, sudden severe vision loss, shallowing of the AC, and dilated and fixed pupil [2, 135]. Intraoperative SCH presents with AC shallowing, hardening of the globe, rapidly progressing black shadow from the back of the eye and absence of red reflex, elevated IOP, posterior capsule stretching, and prolapse of intraocular contents such as the iris, lens/intraocular lens, vitreous, and retina [65, 77].…”

“…It occurs when the long and short ciliary arteries rupture, resulting in the accumulation of blood within the supra-choroidal space [1]. The presence of SCH can result in the forward displacement of the lens-iris diaphragm and aqueous humor accumulation in the posterior chamber, leading to a vicious cycle with extraordinarily high intraocular pressure (IOP) which is challenging to control [2]. In addition to its acute destructive effects, it can lead to cyclodialysis, ciliary body dysfunction, and phthisis bulbi for an extended period [3].…”

“…Stretching of ciliary nerves leads to severe ocular pain [8]. SCH has also been reported following ocular trauma or spontaneously in individuals with specific ocular or systemic risk factors [2, 9]. SCH can be categorized in various ways, including its etiology, the extent of the hemorrhage measured in quadrants, and the degree of elevation.…”

Bilateral Spontaneous Suprachoroidal Haemorrhage Induced by the Valsalva Manoeuvre: A Challenging Diagnosis

“…It occurs when the vortical veins or the long and/or short ciliary arteries rupture, and its most significant risk factor is hypotony, or the sudden intraocular pressure drops during or after ophthalmic surgery 4 , 5 . SCH has also been reported subsequent to ocular trauma, or spontaneously in patients harbouring specific ocular or systemic predisposing risk factors, such as advanced age, atherosclerosis, vascular disease, arterial hypertension, anticoagulation therapy, chronic kidney disease, aphakia, age-related macular degeneration, myopia, and glaucoma 6 7 8 9 10 11 .…”