Optic Disc Hemorrhage Secondary to Glaucoma
During a comprehensive ophthalmic examination 3 or 4 years earlier, a 62-year-old man had been told there were suspicious changes in his eye that suggested glaucoma. His mother had glaucoma and began using timolol maleate eye drops when she was almost 80 years old. Glaucoma is 4 to 8 times more likely to develop in first-degree relatives of persons with primary open-angle glaucoma than in the general population.
During a comprehensive ophthalmic examination 3 or 4 years earlier, a 62-year-old man had been told there were suspicious changes in his eye that suggested glaucoma. His mother had glaucoma and began using timolol maleate eye drops when she was almost 80 years old. Glaucoma is 4 to 8 times more likely to develop in first-degree relatives of persons with primary open-angle glaucoma than in the general population.1
The patient's distance and near visual acuity was correctable to 20/20. Intraocular pressures measured 18 mm Hg. Both optic nerve heads showed extensive excavation, or cupping, from neuroretinal thinning. Temporal thinning of the disc rim was readily apparent in his right eye; a peripapillary retinal hemorrhage immediately adjacent to the optic nerve head margin was also evident. An automated visual field examination confirmed glaucomatous damage in both eyes.
Peripapillary retinal hemorrhages, or Drance hemorrhages, occur more often in normal-tension glaucoma, in which the anterior chamber angle is normal, the intraocular pressure never exceeds 21 mm Hg on diurnal testing, and changes in the optic nerve head and visual field are consistent with glaucoma. One prospective study reported that Drance hemorrhages occurred in 43% of patients with normal-tension glaucoma.2 These hemorrhages can also occur in patients with primary open-angle glaucoma (intraocular pressure exceeds 21 mm Hg), especially if treatment is inadequate. The exact mechanism involved in Drance hemorrhages is not well understood.
Drance hemorrhages can also be an early sign of glaucoma damage and may precede visible glaucomatous changes in the nerve fiber layer or the visual field. Consider these hemorrhages as a sign of disease progression. Medical therapy is warranted for patients with disc hemorrhage who have suspected or diagnosed glaucoma.
b-Blocker eye drop medication for both eyes was prescribed for this patient. His intraocular pressures will be measured every 3 to 4 months. The Collaborative Normal-Tension Glaucoma Study showed that lowering intraocular pressure by 30% significantly reduced the rate of disease progression in patients with normal-tension glaucoma who had visual field loss that threatened fixation.3
REFERENCES:1. Tielsch JM, Katz J, Sommer A, et al, for the Baltimore Eye Survey. Family history and risk of primary open angle glaucoma. Arch Ophthalmol. 1994;112:69-73.
2. Kitazawa Y, Shirato S, Yamamoto T. Optic disc hemorrhage in low-tension glaucoma. Ophthalmology. 1986;93:853-857.
3. Collaborative Normal-Tension Glaucoma Study Group. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Am J Ophthalmol. 1998;126:487-497.
