gms | German Medical Science

Purpose: Macular hemorrhage is a consequence for well-known grounds. The identification of the cause is essential for further management. The Purpose of this case study is to present a unique case of idiopathic macular hemorrhage leading to unilateral central scotoma after excluding the conventional differential diagnosis.

Methods: Retrospective analysis of a single case study. A 26-year-old Caucasian female presented with a central scotoma in her left eye 2 days ago without any precipitating factors. Color fundus photography was performed on the left eye showing left isolated macular hemorrhage. Fundus fluorescein angiography (left eye) showing preretinal blockage due to hemorrhage. An optical coherence tomography (OCT) scan revealed an intraretinal hemorrhage. The patient was informed that she should be observed and reassured her that this condition would likely resolve with short time.

Results: Idiopathic macular hemorrhage (IMH) is a disorder primarily affecting patients younger than 40 years, with no relevant past medical history, along with the absence of retinal, choroidal, systemic or autoimmune diseases, causing a sudden unilateral loss of vision.

Conclusions: Our case represents an unusual presentation of macular hemorrhage which is very rare and usually underestimated. It usually occurs in an otherwise healthy eye, with a higher prevalence in females. The exact pathogenesis of IMH remains unclear and poorly understood. Management is conservative with complete spontaneous resolution, occurring usually within few weeks. High level of awareness for such rare condition can help avoid unnecessary interventions and lower morbidity in that specific patient population.