Bilateral spontaneous hyphaema: case report and review of literature
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Bilateral spontaneous hyphaema: case report and review of literature Aruna Dharmasena • Gillian M. Watts
Ó Springer Science+Business Media New York 2013
Abstract To report a case of bilateral spontaneous hyphaema in a patient on warfarin sodium for atrial fibrillation and COPD. A case report and literature review. A 76-year-old man presented with bilateral spontaneous hyphaema. There was no anterior chamber pathology known to predispose for spontaneous bleeding except for a history of paroxysmal atrial fibrillation treated with a daily dose of 3 mg of warfarin sodium. In addition, he was also suffering from severe COPD and was on oxygen supplementation. This is a rare case of a bilateral spontaneous hyphaema. Although the patient was on warfarin sodium, his INR was only 2.6 at the onset of his symptoms. It may be possible that the combined action of anti-coagulant properties of warfarin sodium and hypoxic vasodilatation of iris vessels may be responsible for bilateral hyphaema in this case. Keywords Hyphaema Bilateral hyphaema Spontaneous hyphaema Warfarin sodium
Introduction Bilateral spontaneous simultaneous hyphaema has only rarely been described. In the previously reported cases the haemorrhage appears to be associated with juvenile xanthogranuloma [1, 2] or microhaemangiomas of iris [3, 4] and in a variety of uveitides [5, 6]. We report a case of bilateral spontaneous hyphaema in a patient who was on anti-coagulant, warfarin sodium in spite of his international A. Dharmasena (&) G. M. Watts Department of Ophthalmology, Royal Bolton Hospital Foundation Trust, Bolton BL4 0JR, UK e-mail: [email protected]
normalised ratio (INR) was maintained within the desired therapeutic range (Fig. 1).
Case report A 76-year-old-man presented complaining of acute onset ocular discomfort and blurred vision in his right eye followed by similar symptoms in his left eye over a period of 4 weeks to our emergency ophthalmic service. He has had bilateral cataract extractions and intraocular lens implants 10–15 months ago. During the pre and post-cataract surgery assessments no obvious ophthalmic co-morbidity was observed. The cataract surgeries were uneventful. During the last post-operative follow-up, which was performed only 6 months ago, his best corrected visual acuity was LogMAR 0.12 and 0.18 in his right and left eyes respectively. He also suffered from chronic obstructive airway disease (COPD) due to bronchiectasis complicated with corpulmonale and chronic hypoxia. He had paroxysmal atrial fibrillation, a previous history of myocardial infarction, hypertension and very well controlled type 2 diabetes mellitus (Haemoglobin A1c (IFCC) 51.0 mmol/mol). He was on goserelin acetate injections for a low-grade adenocarcinoma of prostate. He was on warfarin sodium 3 mg a day and his INR at presentation was 2.6. The target therapeutic range of the INR in his case was between 2 and 3. His other medication included verapamil, glyceryl trinitrate (GTN) spray, frusemide, carbocisteine, salbutamol and atrovent inhale
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