R R

What Is Terson Syndrome?

Terson Syndrome is a specific medical condition where a patient suffers from a vitreous hemorrhage (bleeding inside the eye) as a direct result of a subarachnoid hemorrhage (bleeding in the brain). It was first described by French ophthalmologist Albert Terson in 1900. It serves as a potent reminder of the anatomical connection between the eye and the brain. While a stroke or aneurysm rupture is primarily a neurological event, Terson Syndrome manifests as sudden, profound vision loss in one or both eyes, often complicating the recovery of patients who have just survived a major brain injury.

Link to This Resource Page

Provide a valuable resource to your clients or customers by linking to this resource page. Just place the following link on your website.

To display this...

What Is Terson Syndrome?

Terson Syndrome is a specific medical condition where a patient suffers from a vitreous hemorrhage (bleeding inside the eye) as a direct result of a subarachnoid hemorrhage (bleeding in the brain). It was first described by French ophthalmologist Albert Terson in 1900. It serves as a potent reminder of the anatomical connection between the eye and the brain. While a stroke or aneurysm rupture is primarily a neurological event, Terson Syndrome manifests as sudden, profound vision loss in one or both eyes, often complicating the recovery of patients who have just survived a major brain injury.

read more about terson syndrome ...

Copy this HTML:

Copy HTML Copied!

The Pressure Wave Mechanism

The mechanism behind this condition is hydraulic. When an aneurysm ruptures in the brain, Intracranial Pressure (ICP) spikes instantly. Because the optic nerve is surrounded by a sheath filled with cerebrospinal fluid (CSF) that is continuous with the brain, this pressure wave shoots down the optic nerve sheath like water through a hose. This sudden squeeze compresses the central retinal vein, preventing blood from draining out of the eye. The back-pressure causes the tiny capillaries in the retina to burst, filling the jelly-like vitreous humor with blood.

A Marker of Severity

Clinically, the presence of Terson Syndrome is considered a marker of severity. It correlates strongly with the intensity of the initial brain bleed (often associated with a high Hunt-Hess grade) and is a predictor of higher mortality rates. If a patient arrives at the ER with a severe headache and is found to have blood in their eyes, doctors immediately suspect a massive subarachnoid hemorrhage even before the CT scan is finished. It indicates that the pressure spike in the skull was sudden and extreme.

Diagnosis in Comatose Patients

In comatose patients, Terson Syndrome is often missed initially because the patient cannot complain of vision loss. It is usually diagnosed during a routine screening fundoscopy (looking at the back of the eye) in the ICU. Doctors look for "preretinal" or "vitreous" blood. Sometimes, the blood is so dense that the retina cannot be seen at all. In these cases, an ocular ultrasound (B-scan) is used to visualize the hemorrhage behind the lens and confirm the diagnosis without needing to see through the pupil.

Treatment: Vitrectomy vs. Observation

The treatment of Terson Syndrome is secondary to saving the patient's life. Once the brain aneurysm is secured (coiled or clipped) and the patient stabilizes, the eye is assessed. In many cases, the blood in the vitreous will reabsorb naturally over 3 to 6 months. However, if the blood does not clear, or if it is causing secondary complications like increased eye pressure, a surgery called a pars plana vitrectomy is performed. This procedure mechanically removes the cloudy vitreous gel and peels away any scar tissue, often restoring vision to pre-injury levels since the retina underneath is usually healthy.

FAQs on Terson Syndrome

Does it affect both eyes?

It can. Terson Syndrome is bilateral (affecting both eyes) in approximately 30% to 40% of cases, but it can also present in just one eye depending on how the pressure wave travels.

Is the vision loss permanent?

Usually, no. Unlike a stroke that kills the visual cortex, Terson Syndrome is an obstruction of view (blood blocking the light). Once the blood is removed or absorbed, the vision typically returns.

Can head trauma cause it?

Yes. While it is classically associated with spontaneous aneurysm ruptures, severe Traumatic Brain Injury (TBI) from car accidents or falls can cause the same spike in intracranial pressure and resulting eye bleed.

When to See Your Eye Doctor

If you or a family member has recently survived a stroke or head injury and complains of "black spots," "cobwebs," or total darkness in one eye during recovery, this is likely Terson Syndrome. An ophthalmologist needs to monitor the eye to ensure the retina does not detach behind the blood.

References

https://eyewiki.aao.org/Terson_Syndrome https://pubmed.ncbi.nlm.nih.gov/22425849/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310025/ https://www.strokejournal.org/article/S1052-3057(15)00547-4/fulltext