Papafotiou Eleni, Flindris Konstantinos, Chatzipetrou Chrysa, Kaliardas Athanasios, Koumpoulis Ioannis, Melissourgos Ioannis
Ophthalmology, General Hospital of Ioannina "G. Hatzikosta", Ioannina, GRC.
2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC.
Cureus. 2025 Aug 18;17(8):e90401. doi: 10.7759/cureus.90401. eCollection 2025 Aug.
Spontaneous suprachoroidal hemorrhage is a rare ophthalmic emergency, typically associated with ocular surgery or trauma. However, it can occur spontaneously in anticoagulated elderly patients after a sudden rise in venous pressure, such as during a Valsalva maneuver. We report a rare case of acute angle closure glaucoma secondary to suprachoroidal hemorrhage triggered by severe vomiting in an anticoagulated patient. An 84-year-old male with atrial fibrillation on apixaban was hospitalized for biliary colic. Following repeated vomiting episodes, he experienced sudden, painful vision loss in the left eye. Examination revealed corneal edema, a shallow anterior chamber, a mid-dilated non-reactive pupil, and markedly elevated intraocular pressure (IOP) of 50 mmHg. Imaging demonstrated dislocation of the intraocular lens and angle closure, while B-scan ultrasonography and infrared image confirmed bilateral dome-shaped choroidal elevations consistent with suprachoroidal hemorrhage. Maximal topical and systemic IOP-lowering therapy was initiated. Due to significant comorbidities and high thromboembolic risk, anticoagulation was continued, and surgical intervention was not pursued. The patient's pain was gradually relieved, but visual function did not recover. This case highlights a rare but vision-threatening complication of spontaneous suprachoroidal hemorrhage induced by a Valsalva maneuver in a high-risk patient. In this case, vomiting likely caused a sudden rise in intra-abdominal pressure, leading to rupture of fragile choroidal vessels. The resulting anterior displacement of intraocular structures caused secondary angle closure glaucoma. Prompt diagnosis with B-scan ultrasonography and aggressive medical management are critical, though visual prognosis remains poor in such cases. Surgical drainage is considered in select patients but was contraindicated here. Clinicians should maintain a high index of suspicion for suprachoroidal hemorrhage as a potential cause of acute angle closure in elderly, anticoagulated patients presenting with sudden painful vision loss. Timely diagnosis with B-scan and careful individualized management are crucial, particularly when surgical options are limited by systemic risk factors.
自发性脉络膜上腔出血是一种罕见的眼科急症，通常与眼科手术或外伤有关。然而，在抗凝治疗的老年患者中，静脉压突然升高时，如在瓦尔萨尔瓦动作期间，也可能自发发生。我们报告一例罕见病例，一名抗凝治疗的患者因严重呕吐引发脉络膜上腔出血，继发急性闭角型青光眼。一名84岁男性，因心房颤动正在服用阿哌沙班，因胆绞痛住院。在反复呕吐发作后，他左眼突然出现疼痛性视力丧失。检查发现角膜水肿、前房浅、瞳孔中度散大且无反应，眼压明显升高至50 mmHg。影像学检查显示人工晶状体脱位和房角关闭，而B超和红外图像证实双侧脉络膜呈穹窿状隆起，符合脉络膜上腔出血。开始进行最大程度的局部和全身降眼压治疗。由于存在严重的合并症和高血栓栓塞风险，继续进行抗凝治疗，未进行手术干预。患者的疼痛逐渐缓解，但视功能未恢复。该病例突出了瓦尔萨尔瓦动作在高危患者中诱发的自发性脉络膜上腔出血这一罕见但威胁视力的并发症。在本病例中，呕吐可能导致腹内压突然升高，导致脆弱的脉络膜血管破裂。眼内结构向前移位导致继发性闭角型青光眼。尽管此类病例的视觉预后仍然很差，但通过B超进行快速诊断和积极的药物治疗至关重要。对于部分患者可考虑手术引流，但本病例中为禁忌。临床医生应高度怀疑脉络膜上腔出血是老年抗凝患者突然出现疼痛性视力丧失时急性闭角的潜在原因。通过B超及时诊断并进行仔细的个体化管理至关重要，尤其是当手术选择因全身危险因素而受到限制时。
