Subretinal Peripapillary Hemorrhage Suggestive of Terson Syndrome after Blunt Head Trauma: A Case Report

This case report describes a rare manifestation of subretinal peripapillary hemorrhage after a "trivial" eye injury, suggesting Terson syndrome. The patient, a 42-year-old male, exhibited both ophthalmologic and neurologic symptoms, emphasizing the importance of interdisciplinary assessment in such cases. Despite normal initial visual acuity (VA), the patient experienced sharp retrobulbar pain, photosensitivity, and reduced subjective VA. Multimodal imaging and neurophysiological testing, including optical coherence tomography (OCT) scan, fluorescein angiography (FA), magnetic resonance imaging scan, visual evoked potential (VEP) test, retinal nerve fiber layer (RNFL), and perimetry, were utilized to diagnose the condition. This case highlights the need for prolonged monitoring as symptoms can evolve despite an initially trivial presentation.

We report on a 42-year-old male who presented with sharp retrobulbar pain in his right eye, exacerbated by exertion and movement, along with photosensitivity and subjective reduction in VA. The patient had a history of traumatic brain injury (commotio cerebri) from an accidental impact 12 days prior. A comprehensive clinical examination was conducted, including ophthalmologic imaging (OCT, FA; RNFL) and neurophysiological testing (VEP, magnetic resonance imaging), revealing a large intraretinal hemorrhage surrounding the optic nerve. Indirect ophthalmoscopy (non-contact lens, 90-diopter lens) identified significant intraretinal bleeding in the peripapillary region of the right eye with confirmed large subretinal hematoma in the OCT Scan and with minimal optic nerve edema with venous congestion and irregular filling of the vena centralis inferior (inferonasal retinal vein), during the early phase of the FA. Initial examination revealed a Snellen VA of 1.0 in the right eye and 0.1 in the left, the latter due to severe amblyopia. Consecutive VEP testing showed normal initial VA, but the patient's neuro-ophthalmologic symptoms evolved, resulting in persistent concentration difficulties and neuro-ophthalmologic deficits.

This case illustrates the complexity and potential severity of "trivial" eye injuries, particularly when associated with blunt head trauma. The interdisciplinary approach is crucial for managing such cases due to the risk of evolving neuro-ophthalmologic symptoms. Regular follow-up is recommended to monitor and address new developments in the patient's condition.