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Terson Syndrome Workup

  • Author: Richard J Ou, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Jun 16, 2016

Approach Considerations

The criterion standard for diagnosis is dilated funduscopic examination in the setting of intracranial hemorrhage or another cause of rapidly increased intracranial pressure. The intraocular hemorrhage should be easily visible to the trained examiner. Terson syndrome should be strongly suspected in cases of severe subarachnoid hemorrhage.


Laboratory Studies

Terson syndrome can be diagnosed by its unique clinical presentation of simultaneous intracranial and intraocular hemorrhage. A thorough history must be obtained to rule out causes of preexisting intraocular hemorrhages (eg, diabetic retinopathy, age-related macular degeneration, sickle cell disease, intraocular tumor). In cases associated with trauma, a posterior vitreous detachment, retinal break, or retinal detachment also must be ruled out. Typically, laboratory studies are not critical in making the diagnosis.

Sickle cell preparation may be considered.

Glucose and HbA1c testing may be performed to rule out diabetes, if applicable.


Imaging Studies

Neuroimaging studies, including CT scan, MRI, or angiography, are necessary to document intracranial hemorrhage.

B-scan ultrasound may be necessary to determine the severity of vitreous hemorrhage and to rule out a retinal detachment if no view to the retina is possible, particularly in the setting of trauma.

CT scans have been shown to be inferior to B-scan ultrasonography in identifying intraocular hemorrhage.[29]

Visually evoked potentials has been reported to identify Terson syndrome in a patient who was unable to communicate prior to a full dilated examination.[27]


Other Tests

Examination of the cerebrospinal fluid should be deferred to a neurologist.


Diagnostic Procedures

Both a history and a clinical examination are indicated to help diagnose this condition.


Histologic Findings

Pathologic specimens of patients with Terson syndrome have shown abundant erythrocytes with occasional leukocytes in the vitreous, subhyaloidal and subinternal limiting membrane space, and retina. Clinical case reports have documented subretinal blood, but this is not as common. Epiretinal membranes examined in Terson syndrome show glial cells and basement membrane material.[9]



No staging currently exists.

Contributor Information and Disclosures

Richard J Ou, MD, FACS Clinical Assistant Professor, Baylor College of Medicine; Attending Physician and Consultant, Michael E DeBakey Veterans Affairs Medical Center; Partner, Houston Eye Associates

Richard J Ou, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, Harris County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Brian A Phillpotts, MD, MD 

Brian A Phillpotts, MD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, National Medical Association

Disclosure: Nothing to disclose.


Marc O Yoshizumi, MD Director of Eye Trauma and Emergency Center, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles

Marc O Yoshizumi, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

  1. Litten M. Ueber einige vom allegmein-klinischen Standpunkt aus interessante Augenveranderungen. Berl Klin Wochnschr. 1881. 18:23-27.

  2. Hoving EW, Rahmani M, Los LI, Renardel de Lavalette VW. Bilateral retinal hemorrhage after endoscopic third ventriculostomy: iatrogenic Terson syndrome. J Neurosurg. 2009 May. 110(5):858-60. [Medline].

  3. Khan SG, Frenkel M. Intravitreal hemorrhage associated with rapid increase in intracranial pressure (Terson's syndrome). Am J Ophthalmol. 1975 Jul. 80(1):37-43. [Medline].

  4. Medele RJ, Stummer W, Mueller AJ, et al. Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure. J Neurosurg. 1998 May. 88(5):851-4. [Medline].

  5. Vrabec TR, Sergott RC, Savino PJ, et al. Intermittent obstructive hydrocephalus in the Arnold-Chiari malformation. Ann Neurol. 1989 Sep. 26(3):401-4. [Medline].

  6. Pagani-Estévez GL, Chen JJ, Watson JC, Leavitt JA. Acute Vision Loss Secondary to Epidural Blood Patch: Terson Syndrome. Reg Anesth Pain Med. 2016 Mar-Apr. 41 (2):164-8. [Medline].

  7. Gupta V, Kolomeyer AM, Bhagat N, Turbin RE, Prestigiacomo CJ, Gandhi CD. Subarachnoid hemorrhage-negative Terson syndrome after balloon-assisted coil embolization in a patient with underlying antiphospholipid antibody syndrome. Retin Cases Brief Rep. 2014 Summer. 8 (3):171-4. [Medline].

  8. Jing XB, Sun LQ. Terson syndrome with no cerebral hemorrhage: A case report. Exp Ther Med. 2014 Jan. 7 (1):251-253. [Medline].

  9. Ko F, Knox DL. The ocular pathology of Terson's syndrome. Ophthalmology. 2010 Jul. 117(7):1423-9.e2. [Medline].

  10. Ness T, Janknecht P, Berghorn C. Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage. Graefes Arch Clin Exp Ophthalmol. 2005 Sep. 243(9):859-62. [Medline].

  11. Pfausler B, Belcl R, Metzler R, et al. Terson's syndrome in spontaneous subarachnoid hemorrhage: a prospective study in 60 consecutive patients. J Neurosurg. 1996 Sep. 85(3):392-4. [Medline].

  12. Seif GI, Teichman JC, Reddy K, Martin C, Rodriguez AR. Incidence, morbidity, and mortality of Terson syndrome in Hamilton, Ontario. Can J Neurol Sci. 2014 Sep. 41 (5):572-6. [Medline].

  13. Stienen MN, Lücke S, Gautschi OP, Harders A. Terson haemorrhage in patients suffering aneurysmal subarachnoid haemorrhage: a prospective analysis of 60 consecutive patients. Clin Neurol Neurosurg. 2012 Jul. 114 (6):535-8. [Medline].

  14. Frizzell RT, Kuhn F, Morris R, et al. Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients. Neurosurgery. 1997 Sep. 41(3):529-33; discussion 533-4. [Medline].

  15. Fahmy JA. Fundal haemorrhages in ruptured intracranial aneurysms. I. Material, frequency and morphology. Acta Ophthalmol (Copenh). 1973. 51(3):289-98. [Medline].

  16. Gauntt CD, Sherry RG, Kannan C. Terson syndrome with bilateral optic nerve sheath hemorrhage. J Neuroophthalmol. 2007 Sep. 27(3):193-4. [Medline].

  17. Heyreh SS. An experimental study of the central retinal vein occlusion. Trans Ophthalmol Soc UK. 1964. 84:586-98.

  18. Ogawa T, Kitaoka T, Dake Y, et al. Terson syndrome: a case report suggesting the mechanism of vitreous hemorrhage. Ophthalmology. 2001 Sep. 108(9):1654-6. [Medline].

  19. Michalewska Z, Michalewski J, Nawrocki J. Possible methods of blood entrance in Terson syndrome. Ophthalmic Surg Lasers Imaging. 2010 Nov-Dec. 41 Suppl:S42-9. [Medline].

  20. Fahmy JA. Fundal haemorrhages in ruptured intracranial aneurysms. II. Correlation with the clinical course. Acta Ophthalmol (Copenh). 1973. 51(3):299-304. [Medline].

  21. Schultz PN, Sobol WM, Weingeist TA. Long-term visual outcome in Terson syndrome. Ophthalmology. 1991 Dec. 98(12):1814-9. [Medline].

  22. McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2004 Mar. 75(3):491-3. [Medline].

  23. He T, Wu LN, Chen B, Xing YQ. [Incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage]. Zhonghua Yan Ke Za Zhi. 2011 Dec. 47(12):1096-101. [Medline].

  24. Garweg JG, Koerner F. Outcome indicators for vitrectomy in Terson syndrome. Acta Ophthalmol. 2009 Mar. 87(2):222-6. [Medline].

  25. Sharma T, Gopal L, Biswas J, Shanmugam MP, Bhende PS, Agrawal R, et al. Results of vitrectomy in Terson syndrome. Ophthalmic Surg Lasers. 2002 May-Jun. 33(3):195-9. [Medline].

  26. Garcia-Arumi J, Corcostegui B, Tallada N, et al. Epiretinal membranes in Tersons syndrome. A clinicopathologic study. Retina. 1994. 14(4):351-5. [Medline].

  27. Lee SH, Seo JH, Park SH, Won YH, Ko MH. Terson Syndrome in Aneurysmal Subarachnoid Hemorrhage: A Case Report. Ann Rehabil Med. 2015 Aug. 39 (4):640-4. [Medline].

  28. Gnanaraj L, Tyagi AK, Cottrell DG, et al. Referral delay and ocular surgical outcome in Terson syndrome. Retina. 2000. 20(4):374-7. [Medline].

  29. Bäuerle J, Gross NJ, Egger K, Neubauer J, Niesen WD, Buttler KJ, et al. Terson's Syndrome: Diagnostic Comparison of Ocular Sonography and CT. J Neuroimaging. 2016 Mar. 26 (2):247-52. [Medline].

  30. Kuhn F, Morris R, Witherspoon CD, et al. Terson syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. Ophthalmology. 1998 Mar. 105(3):472-7. [Medline].

  31. Rubowitz A, Desai U. Nontraumatic macular holes associated with Terson syndrome. Retina. 2006 Feb. 26(2):230-2. [Medline].

  32. Shaw HE Jr, Landers MB, Sydnor CF. The significance of intraocular hemorrhages due to subarachnoid hemorrhage. Ann Ophthalmol. 1977 Nov. 9(11):1403-5. [Medline].

  33. Toosi SH, Malton M. Terson's syndrome--significance of ocular findings. Ann Ophthalmol. 1987 Jan. 19(1):7-12. [Medline].

  34. Weingeist TA, Goldman EJ, Folk JC, et al. Terson's syndrome. Clinicopathologic correlations. Ophthalmology. 1986 Nov. 93(11):1435-42. [Medline].

Right eye of a 28-year-old female with subarachnoid hemorrhage 1 week after intracranial surgery.
Left eye of a 28-year-old female with subarachnoid hemorrhage 1 week after intracranial surgery.
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