Abbas A, Hyman G.
Macular Hemorrhage secondary to increased Intrathoracic Pressure and Difficult Intubation.
J Pak Med Assoc Jan ;52(6):265-6.

Retinal hemorrhages are relatively common ophthalmologic findings associated with many ocular as well as systemic disease processes. While identifiable ocular or systemic disease is found in most instances, hemorrhage can also be found in apparently healthy individuals secondary to various forms of physiologic or environmental stress such as that associated with high altitudes, in the newborn, secondary to severe compression injury to the head or body (Purtscher`s Retinopathy). We report a case of macular hemorrhage secondazy to difficult intubation.

A forty year old female patient was refmrred to the Ophthalmology Service for the eviluation of bilateral eyelid ecchymoses and sub-conjunctival hemorrhage which she had developed three days previously during a difficult intubation for status asthamaticus. The patient had not described any visual complaint during her stay in the emergency room prior to intubation and was not documented to be hypertensive at any point during her intubation. The patient had no medical and ophthalmic history. She was on proventil, theophyllin and 20 mg gf prednisone on(an irregular basis. Examination revealed a best (corrected visuad acuity of R.E:(20/60 -- ph -- 20/40 and L.E: 20/60 -- ph -- 20/25. The upper and lower eyelids on both sides were markedly ecchymotic with 360 degrees of sub-conjunctival hemorrhage OU (both eyes). The intra-ocular pressure by applanation tonometry was 20 mmHg in both eyes. The pupils reacted well with no apparent pupillary defect. Dilated fundus examination revealed scattered intra-retinal hemorrhages OU with one in the macula of the right eye, Laboratory tests including PT and APTT were normal. No treatment was instituted and the hemorrhages resolved over the next few weeks with no recurrence.

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