Subepithelial Corneal Hemorrhage

BY BRADLEY G. SMITH, O.D.
JUNE 1996

Neovascularization is a common complication in soft contact lens wearers. This is due to a lack of oxygen to the cornea which then sends out neotaxic factors that cause blood vessels to grow into the peripheral cornea. These new vessels are weak in the lumin walls, creating the possibility of vascular rupture and hemorrhage.

SUBEPITHELIAL CORNEAL HEMORRHAGE IS AN UNCOMMON COMPLICATION OF LONG-TERM SOFT CONTACT LENS WEAR.

This 32-year-old female was a long-term, daily wear, soft contact lens wearer who reported she had blood in the clear part of her eye. She has no family history of eye disease. Corrected visual acuities were 20/20 OU. Slit lamp examination of the cornea revealed a hemorrhage between the corneal epithelium and the corneal stroma. The hemorrhage originated from the peripheral neovascular vessels in the inferior nasal cornea. The blood pooled between the epithelium and the stroma, pushing its way superiorly. We advised the patient to discontinue contact lens wear, and we recommended daily follow-up visits for three days. No treatment was prescribed.

This case resolved quickly over the next seven days. By the third day, two large sections of the hemorrhage had been reabsorbed or dissipated through the epithelium. The patient reported that sections of the hemorrhage would dissipate all at once. By the seventh day, only slight remnants remained. One week later, we advised the patient that she could resume wearing her daily disposable lenses. The patient has had no further corneal problems.

Subepithelial corneal hemorrhage is an uncommon complication of long-term soft contact lens wear. In this case, I judged the neovascularization to be approximately 1mm to 1.5mm into the cornea, which is normal for a long-term soft contact lens wearer. This complication turned out to be minor and resolved quickly.

This photograph was taken with a Nikon FS-2 slit lamp. The flash setting was at a level #2 and the background illumination was set in the medium position. We used Kodak Kodachrome film. In this photographic setup, we obtained the best results by using a slit beam, which allowed both direct and indirect illumination of the hemorrhage. CLS

Dr. Smith is in a large group practice in Tigard, Ore., with his father Jack F. Smith, O.D.