Retinal hemorrhages

Roth spots are rarely occurring (in less than 5% of IE cases), oval-shaped retinal hemorrhages with a pale center near the optic disc (Fig. 71-3D). 

The funduscopic examination may reveal arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, and retinal hemorrhages, exudates, and infarcts. The presence of papilledema indicates hypertensive emergency requiring rapid treatment. 

A 40-year-old black man is seen in the emergency room for a severe headache. His blood pressure is 180/110 mm Hg, and he has evidence of retinal hemorrhage. An infusion of nitroprus-side is given. 

Ophthaimoiogic disorders Decrease or loss of vision, retinopathy (including macular edema, retinal artery or vein thrombosis), retinal hemorrhages and cotton wool spots, optic neuritis, and papilledema are induced or aggravated by treatment with peginterferon alfa-2a or other alpha interferons. All patients should receive an eye examination at baseline. 

Uses Rx Sxs of peripheral vascular Dz Action X Blood cell viscosity, restores RBC flexibility Dose Adults. 400 mg PO tid pc Rx min 8 wk for effect X to bid w/ GI/CNS SEs Caution [C, +/-] Contra Cerebral/retinal hemorrhage Disp Tabs SE Dizziness, HA, GI upset Interactions t Risk of bleeding W7 anticoagulants, NSAIDs T effects OF antihypertensives, theophylline EMS t Effects of anticoagulants OD May cause lethargy, pyrexia, skin flushing, hypotension, and Szs symptomatic and supportive... 

Contraindications History of intolerance to xanthine derivatives, such as caffeine, theophylline, or theobromine recent cerebral or retinal hemorrhage... 

Retinal hemorrhage occurred in four women after they had received epidural methylprednisolone for chronic back and hip pain (SEDA-20, 373 77). Retinal and choroidal vascular occlusions are a serious and sometimes lasting complication of periocular and facial injections of glucocorticoids (SEDA-21, 416). 

Kushner FH, Olson JC. Retinal hemorrhage as a consequence of epidural steroid injection. Arch Ophthalmol 1995 113(3) 309-13. 

Eisner A, Falardeau J, Toomey MD, Vetto JT. Retinal hemorrhages in anastrozole users. Optom Vis Sci 2008 85(5) 301-8. 

Angiogenesis driven by myocardial hypoxia may permit collateral formation, relief of angina, and minimize tissue damage during myocardial infarction. On the other hand, hypoxic drive to retinal neovascularization can contribute to retinal hemorrhage and blindness. 

Three patients taking paroxetine for interferon-alpha-induced depression developed retinal hemorrhages, including one with irreversible loss of vision (6). 

Kelly, J.S., Sophocleus, G.J. (1978). Retinal hemorrhages in sub acute carbon monoxide poisoning. Exposure in homes with block furnaces. JAMA 239 1515-17. 

A 3-year follow-up of the patients in the ONTT demonstrated that treatment with intravenous methylprednisolone followed by oral corticosteroid regimens reduced the 2-year rate of MS development.The 10-year follow-up of the ONTT found that 92% of affected eyes had 20/40 or better vision. There was a 35% recurrence of optic neuritis, which was greatest in those patients who developed MS. Patients who were at the lowest risk category were those with a normal MRI, male gender, painless vision loss, profound disc edema, optic disc or retinal hemorrhages, and retinal exudates on presentation. 

Retinal vascular diseases, such as vascular occlusions, hemorrhage, retinal venous thrombosis Retinal hemorrhage... 

Salicylates are well known to have anticoagulant properties. In high dosages or with prolonged use these drugs can cause retinal hemorrhage. 

Delayed corneal epithelial wound healing, PSC, decreased resistance to infection, decreased tear lysozyme, eyelid and conjunctiva hyperemia/edema/angioneurotic edema, subconjunctival hemorrhage, translucent blue sclera, increased lOP, myopia, exophthalmos, intracranial hypertension causing papilledema, diplopia, EOM paresis and eyelid ptosis, retinal hemorrhages (secondary to injection), central serous choroidopathy, abnormal ERGA EP, retinal embolic phenomenon (injection). 

May increase bleeding tendencies (subconjunctival hemorrhage, retinal hemorrhage). 

Severe retinal hemorrhage with a slowly reversible loss of visual acuity, and massive vitreous hemorrhage recurring after further G-CSF treatment and resulting in irreversible loss of vision in the affected eye have each been reported in single patients (SEDA-21, 378) (SEDA-22, 408). Concomitant hyperleukocytosis was suggested as a possible cause in the first patient, whereas G-CSF-induced reactivation of primary ocular inflammation (probably infectious in origin) was advanced as an explanation in the second case. 

Ibuprofen significantly correlated with high-altitude retinal hemorrhages (SEDA-17,110). 

In one study, in which prospective ophthalmic examinations were made before and at regular 2-week intervals after the beginning and end of treatment, 28 of 81 patients who received a uniform total dose of natural interferon aha (478 MU) for chronic hepatitis C developed the typical findings of interferon-induced asymptomatic retinopathy (cottonwool spots and/or retinal hemorrhages) (84). In contrast, there were no lesions in the 25 patients with chronic hepatitis C who did not receive interferon alfa or in the 20 with diabetes mellitus and/or hjrpertension but without chronic hepatitis C. Most of the cases were observed within 4 months of treatment, and the lesions always abated after withdrawal or even despite continuation, suggesting that treatment can be continued unless patients develop sjmp-toms. Indeed, most patients with retinopathy associated with interferon alfa remained asymptomatic. 

Phenylbutazone can damage the eyes. Conjunctivitis, damage to the cornea with vascularization and scarring, adhesion of the lids to the eyeballs, amblyopia, retinal hemorrhage, and even blindness have been reported (12). 

Uveitis in combination with meningitis (47) and uveitis in combination with arthritis and Stevens-Johnson syndrome (48) have been reported with trimethoprim. Uveitis with retinal hemorrhages has also been described (49). 

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