Hemorrhagic corneal pannus simulating a spontaneous expulsive hemorrhage

An elderly, Spanish-speaking patient, who was a poor historian, presented with a hemorrhagic corneal condition that was mistakenly diagnosed as a spontaneous expulsive choroidal hemorrhage leading to enucleation of the globe. The enucleation specimen revealed pathologically a diffuse hemorrhagic pannus without corneal perforation in an eye with end-stage chronic angle closure glaucoma. The absence of clear-cut antecedent trauma, corneal ulceration, and pain at the time of presentation should have militated against the mistaken diagnosis. Diagnostic tests to establish more securely the diagnosis of expulsive hemorrhage are summarized.