✓ The eyes of 23 patients with sudden intracranial hypertension were studied at post-mortem. Intraocular hemorrhage had occurred in 37% and optic nerve sheath hemorrhage in 87%. Expansion of the optic nerve sheath, particularly the fusiform retrobulbar portion, was a consistent finding. The subdural space of the optic nerve sheath bore the brunt of the hemorrhage which sometimes communicated with perivascular intradural hemorrhages. Optic nerve sheath hemorrhage is shown to result from rupture of dural and bridging vessels of the optic nerve sheath; this we conclude is subsequent to optic nerve sheath dilatation caused by the transmission of intracranial pressure through the subarachnoid communication between the optic nerve sheath and the intracranial cavity. Intraocular hemorrhage is the result of retinal venous hypertension and rupture brought on by obstruction of both the central retinal vein and the retinochoroidal anastomosis.

Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension.

Methods: Papers relating to vitreous haemorrhage in patients with subarachnoid haemorrhage were retrieved. The only studies considered were those with at least 10 consecutive cases of subarachnoid haemorrhage with or without vitreous haemorrhage. The frequency of vitreous haemorrhage in such cases was calculated in prospective and retrospective studies. Mortality was compared in patients with and without Terson's syndrome. 

Results: 154 papers were reviewed. Three prospective studies and six retrospective studies satisfied the inclusion criteria. Of 181 patients with subarachnoid haemorrhage assessed prospectively (mean age, 51.7 years), 24 (13%) had vitreous haemorrhage; among 1086 retrospective records, 37 (3%) had documented vitreous haemorrhage (p<0.001). Patients with Terson's syndrome had higher Hunt and Hess grades than those without (mean grade, 3.6 v 2.6). Patients with Terson's syndrome were also more likely to die (13 of 30 (43%) v 31 of 342 (9%); odds ratio 4.8; p<0.001). 

Conclusions: Prospective studies show a higher frequency of Terson's syndrome than retrospective studies, suggesting that vitreous haemorrhage is not well documented. Vitreous haemorrhage is an adverse prognostic finding in patients with subarachnoid haemorrhage.

https://jnnp.bmj.com/content/jnnp/75/3/491.full.pdf

A systematic review of Terson’s syndrome: frequency and prognosis after subarachnoid haemorrhage

Subarachnoid Hemorrhage: Intraocular symptoms and their pathogenesis

✓ Terson's syndrome refers to the occurrence of vitreous hemorrhage with subarachnoid hemorrhage (SAH), usually due to a ruptured cerebral aneurysm. Although it is a well-described entity in the ophthalmological literature, it has been only rarely commented upon in the neurosurgical discussion of SAH. Fundus findings are reported in a prospective study of 22 consecutive patients with a computerized tomography- or lumbar puncture-proven diagnosis of SAH. Six of these patients had intraocular hemorrhage on initial examination. In four patients vitreous hemorrhage was evident on presentation (six of eight eyes). In the subsequent 12 days, vitreous hemorrhage developed in the additional two patients (three of four eyes) due to breakthrough bleeding from the original subhyaloid hemorrhages. The initial amount of intraocular hemorrhage did not correlate with the severity of SAH. Two of the six patients with intraocular hemorrhage died, whereas five of the 16 remaining SAH patients without intraocular hemorrhage...

Terson's syndrome: a reversible cause of blindness following subarachnoid hemorrhage.

Long-term visual outcome in Terson syndrome.

Introduction THE not infrequent occurrence of haemorrhage into the subarachnoid space within the skull has long been known, but up to relatively recent times mainly as a cause of death in cases in whiclh an incorrect diagnosis had been made during life. It was not associated in the minds of clinicians with any distinctive symptomatology, and in consequence the belief was generally held that its recognition was almost impossi'ble at the bedside and its outcome usually fatal. But after the introduction of lumbar puncture by Quincke over twenty years ago it was fou;nd that the presence of blood in the spinal fluid under certain circumstances was a clear indication of bleeding into the subarachnoid space. Since then many important papers have been devoted to the subject, but our knowledge of it nevertheless is by no means complete. Aetiologically there are three main groups of cases: stibarachnoid haemorrhage from: (1) traumatic rupture of menipgeal vessels; (2) primary intracerebral haemorrhage, the blood usuavlly reaching the subarachnoid space by bursting through the brain substance; (3) non-traumatic rupture of a meningeal vessel or aneurysm.

https://bjo.bmj.com/content/bjophthalmol/9/5/209.full.pdf

On the relationship between subarachnoid and intraocular haemorrhage.

On the Relationship between Sub-arachnoid and Intra-ocular Haemorrhage.

very well indeed. After six months he came back and was practically normal. Concerning the transmission of the condition from one tuberculous subject to another, he saw an interesting case seven or eight years ago in which a girl had what was clinically a primary chancre of the lip, which was subsequently proved to be tuberculous, and it was then found that her fiance was suffering from open tuberculosis of the lungs.

The Control of Ocular Pain.

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On the Relationship between Subarachnoid and Intra-ocular Hæmorrhage

IN 1883, Mr. Henry Power read a paper before the Odontological Societv \" On the Relations between Dental Lesions and Diseases of the Eye.\"l In that paper, after referring to earlier observations that had been made in connexion with the relation of disease of the teeth and eyes, he went on to discuss the sympathetic nervous relations between the teeth and eyes, using as his text the analogy of sympathetic inflammation of an eye following injury to its fellow. It was then thought that sympathetic pphthalmitis was purely a reflex nervous phenomenon, and on these grounds were discussed paralysis of the various ocular muscles, which was in certain cases stated to be due to irritation of the branches of the fifth cranial nerve. Many diseases of the eye have been attributed to disease of the teeth, such as blindness, squint, paralysis of muscles supplied by the third and seventh cranial nerves, and glaucoma. There was a long discussion after this paper in which many speakers quoted cases in their own experience, and mention was made, besides the above conditions, of phlyctenular ophthalmia, cataract, conjunctivitis, spasm of the orbicularis, hypermetropia, lachrymation, and others. Such conditions as these will not be dealt with in this paper; it is with diseases of the eye due to infection either with organisms or their products, and with those cases especially in which these causes of diseases seem to have originated in connexion with the teeth-namely, with oral sepsis. The eye may become infected in two ways, either by a perforating wound-exogenous infection-or by way of the blood-stream-endogenous infection.

Charles Goulden

Papers

On the relationship between subarachnoid and intraocular haemorrhage.

On the Relationship between Sub-arachnoid and Intra-ocular Haemorrhage.

The Control of Ocular Pain.

On the Relationship between Subarachnoid and Intra-ocular Hæmorrhage

Some Inflammatory Eye Conditions due to Oral Sepsis.