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A 62-year-old woman presented for a routine eye examination. She had a positive family
history for glaucoma. Her visual acuity was 20/20 in both eyes, and her pupils were
reactive. Intraocular pressure was 22 mm Hg in the right and left eyes. Funduscopic examination of the left eye was normal;
but a splinter hemorrhage was found in her right optic disc (Figure 1), and as a consequence, glaucoma was diagnosed. Campimetry was normal; therefore,
metabolic control and a prostaglandin analog were started. Glaucoma is an important
cause of preventable blindness, which is permanent if untreated; according to the
World Health Organization, it is the second leading cause of blindness. Half of the
patients with glaucoma are not diagnosed because of its asymptomatic and insidious
onset. However, a complete ophthalmologic physical examination searching for the characteristic
structural changes of the optic nerve head exceeds 90% for confirmation of the diagnosis
of glaucoma. Classical features include enlargement or asymmetry of the cup, thinning
of the neuroretinal rim or disc hemorrhages. Disc hemorrhages are a typical clinical
sign; its presence alone is almost a guarantee of glaucoma. They are flame or splinter-like
in shape, often with characteristic feathered ends. They have a radially and perpendicular
orientation to the optic disc margin and extend from within the optic nerve head to
the peripapillary retina. Reported rates for this type of hemorrhage range from 0%
to 0.4% in normal patients, 2% to 37% in primary open angle glaucoma and 11% to 42%
in normal tension glaucoma.
Unfortunately, disc hemorrhages are very difficult to spot during eye examination
because of their subtle and self-limited condition; they may resolve in just a couple
of weeks up to 2 months. Detection rates increase just by expending an extra time
on fundoscopic examination and knowing that its presence is indicative of glaucoma
with a poor prognostic factor that must be referred to an ophthalmologist for appropriate
treatment.
Figure 1Normal left optic disc. Right optic disc with a splinter hemorrhage.
