Terson's syndrome in subarachnoid hemorrhage.

Manuscript received November 20. 1997: accepted Februap 20, 1998. From the Department of Ophthalmology (A.M.F.W.. W-C.L.) and the Seuro-ophthalmology Unit (J.A.S). Division of Nturolog!. the Toronto Hospital and the University of Toronto. Ontario. Canada. Address correspondence and reprint requests to Dr. James A. Sharpe. Division of Neurology. the Toronto Hospital. EC 5-04?. 399 Bathurst Street. Toronto. Ontario. Canada M5T 2S8. preretinal. and \-itreous hemorrhage (Fig. 2). Terson's syndrome was diagnosed. and obsenation was recommended. Three months later. the patient's visual acuity was 20125 OL'. and the hemorrhage resolved. Terson's syndrome refers to the occurrence of \.itreous hemorrhage with tSXH) ( 1 ). Intraocular hemorrhagesubretinal. intraretinal. and preretinal (subhyaloidkcan also occur ( 2 ) . Garfinkle et al. (2) observed vitreous hemorrhage in 3% to 5% of patients with SAH. whereas intraocular hemomhage without vitreous hemorrhage occurred in 20% to m% ( 2 ) . The pathogenesis of Terson's syndrome is unclear. One widely accepted theory (3) suggested that the sudden increase in intracranial pressure in SAH is transmitted to the optic nene sheath through the subarachnoid communication between the ovtic canal and intracranial cavity. The optic nerve sheath dilates and compresses both the central retinal vein and retinochoroidal anastomoses. thus reducing retinal venous drainage. with rupture of retinal vessels and hemorrhage into~the vitreous. Patients with Tenon's syndrome have a poor prognosis. with a mortality rate that is twice that ~f'~atie;ts with SAH in whom there is no vitreous hemorrhage (2 ) . For those who sunive. visual recovery is usually good as the intraocular hemorrhage slowly resolves (4), and conservative management is recommended. Patients should be followed for ocular complications sbch as glaucoma and epiretinal membrane. Nonclearing vitreous hemorrhage may benefit from vitrectomy (5).