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.^{[33, 34]}

Visually evoked potentials has been reported to identify Terson syndrome in a patient who was unable to communicate prior to a full dilated examination.^[30]

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.^[10]

Staging

No staging currently exists.

Treatment & Management

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Media Gallery

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.