The ocular pathology of Terson's syndrome

Purpose: To improve understanding of vision loss and clinical findings, we studied gross and microscopic pathology of retinas and optic nerves of individuals with Tersons syndrome. Design: Retrospective case series with clinicopathologic correlation. Participants: We included 109 deceased individuals with Tersons syndrome. Methods: Histologic sections and gross photographs from 109 cases of Tersons Syndrome, accessed from 1955 to 1992 at the Wm R. Green Laboratory of Ocular Pathology, were studied and photographed; a representative case is described in detail. Main Outcome Measures: Abnormalities in retina and optic nerve. Results: Hemorrhages occur in vitreous, subhyaloid, sub-internal limiting membrane (ILM), intraretinal, and subretinal spaces, in association with macular holes, retinal detachments, and optic neuropathy. Subhyaloid hemorrhages have diffuse morphology, whereas sub-ILM are well-demarcated. Continuous and noncontinuous blood occurs along optic nerves, within nerve sheaths, and in the subdural and subarachnoid spaces. Conclusions: Blood occurring in various layers and locations of the retina, particularly the macula, causes various complications that influence clinical management and visual outcome. Morphology differentiates subhyaloid from sub-ILM hemorrhage. Patterns of hemorrhages of optic nerve contribute to understanding mechanisms of Tersons syndrome.