Terson Syndrome – Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre

Abstract

Purpose The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal. Patients and Methods A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome. Results Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman’s rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman’s rho = 0.688, p=0.005). Conclusion Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.

Terson's syndrome leading to fatal outcome in a 36-year-old woman: A case report

“…This is attributed to the fact that routine ophthalmologic examinations are not consistently conducted, and some patients are unable to communicate their visual complaints due to their underlying medical conditions. This assertion is corroborated by a study conducted by Lima-Fontes et al [8] in 2023, wherein the authors underscored that the diagnosis of Terson's syndrome commonly encounters delays. This delay is attributed to the concurrent presence of neurological deficits and a compromised conscious state in affected individuals.…”

“…The incidence of Terson's syndrome varies from 8% to 46% as a result of differences in the diagnostic method. The frequency of Terson's syndrome is relatively high and yet 77% of such cases are overlooked in daily reports [ [8] , [9] , [10] ]. In a systematic review of 154 scholarly works on the incidence of Terson's syndrome, McCarron et al [11] reported a 13% frequency among patients studied prospectively and 3% studied retrospectively.…”

“…The presence of vitreous and preretinal hemorrhage without associated cerebral hemorrhage creates challenges for ophthalmologists and neurosurgeons and reduces the suspicion of Terson's syndrome [7] . The reported incidence of Terson's syndrome is 12.5%-40.0% [8] . Recent studies have highlighted the need for increased awareness and clinical suspicion of Terson's syndrome.…”

Terson Syndrome Diagnosed by Ocular Point of Care Ultrasound on the Medical Floor

“…It is important to note that delays in identifying Terson syndrome can result in poorer visual outcomes and associated morbidity. Patients with Terson syndrome who are not adequately managed are at risk of developing perimacular folds, retinal detachment, and ghost cell glaucoma 9 .…”

Bilateral Subinternal Limiting Membrane Crystalline Deposits Secondary to Terson Syndrome

“…The management options of sub-ILM hemorrhage can vary depending on multiple parameters, such as the general condition of the patient, visual acuity, bilaterality, location, severity of the hemorrhage, and time since its onset, associated ocular pathology [ 3 , 5 ]. Treatment options could include observation, YAG laser hyaloidotomy, or pars plana vitrectomy with ILM peeling and aspiration of the underlying hemorrhage [ 5 , 6 ]. In most cases of TS, spontaneous recovery is expected, and therefore, conservative treatment is usually opted for [ 1 ].…”