Hemorrhagic ocular complications associated with the use of systemic thrombolytic agents

This study aimed to report three patients with hemorrhagic ocular and orbital complications associated with the use of systemic thrombolytic agents.

The study design was a retrospective small case series.

Three eyes of three patients were studied.

Surgical procedures to reduce intraocular pressure or relieve optic nerve compression were performed.

Visual acuity and intraocular pressure were measured.

Three patients received an intravenous thrombolytic agent on diagnosis of an acute myocardial infarction. One patient had a spontaneous suprachoroidal hemorrhage develop with secondary acute angle closure glaucoma shortly after receiving tissue plasminogen activator. Another patient had an orbital hemorrhage develop on receiving tissue plasminogen activator 4 days after an uncomplicated cataract extraction. The third patient experienced an orbital hemorrhage while receiving streptokinase 1 day after undergoing an external levator resection. Two patients suffered significant visual loss due to glaucoma or compressive optic neuropathy.

The onset of eye pain or visual loss after the administration of a systemic thrombolytic agent should alert the physician to the possibility of an ocular or adnexal hemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favorable visual outcome.