Peripapillary subretinal hemorrhage (PSH) syndrome is most common in young, myopic adult patients (with a mean age of 20 years) who also exhibit tilted optic discs, according to a recently published study.

Researchers in China looked into 38 eyes of 37 consecutive PSH patients and noted their demographic profiles, possible etiologies, clinical features, prognoses and outcomes.

PSH presents with variable clinical manifestations, the researchers noted. It can appear alone or in concert with intrapapillary hemorrhage (IPH) or intrapapillary bleeding accompanying vitreous hemorrhage. Primarily, they found it is usually unilateral. In addition to PSH, they noted IPH was present in 89.5% of eyes and vitreous hemorrhage was present in 44.7%. There were no instances of IPH alone or IPH combined with vitreous hemorrhage that did not also exhibit PSH.

All patients exhibited an acute onset at first presentation, in which the patients complained of blurred vision, floaters, smudges in the visual field and reduced visual acuity. One patient reported vomiting, another experienced coughing, two noted constipation just prior to onset and four reported elevated anxiety associated with high school final exams. None had significant prior medical problems or signs of trauma. They also all had myopia with a mean spherical equivalent of 3.37D±1.77D. Four eyes had high myopia (spherical equivalent >6.0D), 17 eyes had moderate myopia (spherical equivalents of 3.0D to 5.75D) and 17 had mild correction (spherical equivalents of 0.25D to 2.75D). After a mean follow-up of 2.85 months, all hemorrhages resolved spontaneously without sequelae.

“Notably, PSH is not a single entity,” the researchers write in their publication. “We postulate that its causes may include sudden movement of myopic eyes with elevated optic discs. It is easy to misdiagnose PSH as optic disc edema, papillitis, buried optic nerve drusen or other phenomena. The challenge for clinicians is to recognize the characteristics of PSH and distinguish this condition from others with similar features.”