A subhyaloid haemorrhage as the presenting symptom of bilateral optic neuropathy

A 28 year-old man with a spontaneous vitreous haemorrhage as the first sign of Leber's optic atrophy is presented. The blood collected in a central retrohyaloid area covering the left macula. The exact starting point of the haemorrhage was never positively identified, but it seemed to originate from an area of microangiopathy adjacent to the optic disc. For 8-10 months the vision of the left eye gradually decreased to counting fingers. A year later the visual acuity dropped to the same level on the right eye. The picture was compatible with Leber's optic atrophy. Other disorders causing bilateral optic neuropathy were excluded. A careful family history revealed several cases of visual problems for several generations. Vitreous haemorrhage as the first sign of Leber's optic atrophy has not previously been reported. Peripapillar microangiopathy, however, has been described in the asymptomatic stage of the disease.