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Year : 2018  |  Volume : 30  |  Issue : 3  |  Page : 198-199

An unusual case of a spontaneous uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia

1 Department of Ophthalmology, IGMC Shimla, Himachal Pradesh, India
2 Department of Ophthalmology, Dr. RPGMC, Tanda, Himachal Pradesh, India

Date of Web Publication17-Dec-2018

Correspondence Address:
Tarun Sood
Senior Resident, Department of Ophthalmology, IGMC Shimla, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_74_18

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Description of an unusual case of a spontaneous Uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia is presented. The literature is reviewed with particular reference to the etiology of spontaneous hyphema and relation of fibrinous uveitis with the fibrin degradation product.

Keywords: Fibrinous uveitis, immune thrombocytopenic purpura, spontaneous hyphema

How to cite this article:
Sood T, Panwar P, Tomar M. An unusual case of a spontaneous uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia. Kerala J Ophthalmol 2018;30:198-9

How to cite this URL:
Sood T, Panwar P, Tomar M. An unusual case of a spontaneous uncomplicated hyphema and fibrinous uveitis secondary to immune thrombocytopenia. Kerala J Ophthalmol [serial online] 2018 [cited 2022 Oct 7];30:198-9. Available from: http://www.kjophthal.com/text.asp?2018/30/3/198/247591

  Introduction Top

Immune thrombocytopenia (ITP) is a heterogeneous syndrome of unknown etiology characterized by a reduction in the platelet count, normal or increased number of bone marrow megakaryocytes, and a shortened platelet life span. The mechanism is presumed to be either antiplatelet antibodies or immune-complex mediated destruction by reticuloendothelial cells.

  Case Report Top

The patient, a 59-year-old man, a banker by profession presented with a 3-day history of a red, painful right eye, and diminished visual acuity OD. There was no history of trauma. History of epistaxis and malena was also present. His visual acuity was recorded as 6/9 right and 6/6 left. Intraocular pressure was recorded to be 12 and 15 mm by noncontact tonometer. Detailed slit-lamp examination revealed hyphema with fibrinous anterior uveitis in the right eye [Figure 1]. Fundus examination was unremarkable in the left eye and dilated indirect ophthalmoscopy also revealed no abnormality in the left eye patient was prescribed gatiquin-prednisolone drops 6 times a day along with homatropine 3 times a day. Hyphema resolved in a period of 4 days while fibrinous uveitis resolved over a period of 7 days.
Figure 1: Slit-lamp examination image revealing fibrinous uveitis and spontaneous hyphema

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Investigations revealed a leukocyte count of 7000 and a platelet count 85000. The white cell differential count was normal. His antinuclear factor was positive and the DNA binding 35 units/ml (normal = 1–25). Fibrin degradation product (FDP) was increased (>5 < 20). A provisional diagnosis of immune thrombocytopenia (ITP) was made. While the hyphema could be related to ITP, in the absence of any other cause for uveitis, increased levels of FDP could be related to fibrinous uveitis. Uveal deposition of immune complexes causes secondary platelet damage and intravascular coagulation which results in uveal tissue damage through inflammation.

Normal cellularity with an increased number of megakaryocytes was found in bone marrow aspirate, consistent with peripheral destruction or sequestration of platelets. Blood coagulation tests gave normal results and there was no splenomegaly. Although indirect immunofluorescence tests were negative for platelet antibodies, these findings were compatible with a diagnosis of ITP.

  Discussion Top

Ocular trauma is usually associated with anterior segment hemorrhage. Retinoblastoma, juvenile xanthogranuloma, abnormal anterior chamber vessels associated with iris melanoma or rubeosis secondary to diabetes mellitus or Fuchs's uveitis syndrome can cause spontaneous hemorrhage.[1],[2],[3] Persistent primary vitreous Fibrovascular membranes of retrolental fibroplasia, retinoschisis can also bleed into the anterior chamber leading to spontaneous hyphema. Hemorrhage from iris neovascular tufts near the pupillary frill was first reported in 1973.[4] Anterior uveitis associated with herpes zoster, diabetes mellitus, and Beqet's syndrome can also cause hyphema.[5] A total of 16 cases of spontaneous hypema and corneal hemorrhage as a complication of microbial keratitis were reported by Ormerod and Egan in 1987.[6] Blood dyscrasias, notably leukemia, hemophilia, sickle cell anomalies, and malignant lymphoma also present as spontaneous hypema.[7] A case of spontaneous hyphema secondary to ingestion of aspirin and alcohol, related presumably to a reduction in platelet function has been reported by Kageler et al.[8]

  Conclusion Top

Spontaneous hyphema is relatively uncommon. ITP should be kept as a differential diagnosis of spontaneous hyphema particularly when history of epistaxis and malena are present. The role of FDP in fibrinous uveitis needs to be correlated.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Frazer DJ, Font RL. Ocular inflamation and haemorrhage as initial manifestations of uveal malignant melanoma. Incidence and prognosis. Arch Ophthalmol 1979;97:1311-4.  Back to cited text no. 1
Howard GM. Spontaneous hyphema in infancy and childhood. Arch Ophthalmol 1962;68:615-21.  Back to cited text no. 2
Liesegang TJ. Clinical features and prognosis in fuchs useitissyndrome. Arch Oplithalmol 1982;100:1622-6.  Back to cited text no. 3
Maguran D. Unilateral spontaneous hyphaema. Br JOphthalmol 1973;57:945-7.  Back to cited text no. 4
Doggart JH. Spontaneous hyphaema. In: Acta XVI Concililum Opthalmologicum Brittania. Vol. 1. London: British Medical Association; 1951. p. 450.  Back to cited text no. 5
Ormerod LD, Egan KM. Spontaneous hyphaema and cornealhaemorrhage as complications of microbial keratitis. Br JOphthalnmol 1987;71:933-7.  Back to cited text no. 6
Massa JM, De Vloo N, Jamotton L. The ocular manifestations of Hematologic Diseases. Bdll Soc Beqge Oplitalnmol 1966; 142: 415-34.  Back to cited text no. 7
Kageler WV, Moake JL, Garcia CA. Spontaneous hyphemaassociated with ingestion of aspirin and ethanol. Am J Ophthalmol 1976;82:631-4.  Back to cited text no. 8


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