Spontaneous Expulsive Suprachoroidal Haemorrhage in an Asymptomatic Elderly Patient: a Case Report

Purpose: To describe a rare case of spontaneous expulsive suprachoroidal haemorrhage (SESCH) in an asymptomatic elderly patient.

Method: This is a case report of a 76-year-old Chinese female, presented as an emergency with spontaneous left eye bleeding. She had underlying uncontrolled hypertension, no other systemic illness and not on anticoagulant. She has a history of right eye cataract operation, right eye angle-closure glaucoma and left eye absolute glaucoma complicated with painless left blind eye. Ocular examination over left eye showed no light perception and demonstrated presence of fresh bleed, expulsion of lens and prolapsed uveal contents, while right eye examination was unremarkable. Patient subsequently underwent evisceration and was uneventful.

Results: Routine blood investigations including coagulation profile came back as normal. Surgical findings include perforated cornea more than three-fourths with prolapsed uveal contents and fragile conjunctiva. No other significant macroscopic conditions were noted. Histology and culture came back with growth of Pseudomonas aeuroginosa with no evidence of malignancy.

Discussion: SESCH is a rare but serious sight-threatening ocular condition associated with multiple risk factors including arteriosclerosis, vascular disease, glaucoma, diabetes, intraocular malignancy and diseased eye wall. The predisposing factors involved in this case include advanced age, glaucoma with persistent high intraocular pressure, uncontrolled hypertension and presence of infection.