Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease
A 57-year-old Female patient who was admitted for decompensated cirrhosis of liver developed sudden onset of ocular pain associated with loss of vision. Ocular examination revealed peribulbar hemorrhage, lid edema, conjunctival congestion with chemosis, and mild (2 mm) proptosis. Perception of light was absent. Cornea was clear. Anterior chamber was of normal depth with a 2 mm hyphema. Fresh Vitreous hemorrhage with no view of fundus was noted, and the intraocular pressure was 44 mmHg. Left eye examination was normal. Patient denied history of trauma of any nature and had no past history of any ocular ailment.\nThe patient was started on timolol 0.5% eye drops and oral Acetazolamide 250 mg 6 hourly. After 24 hours, on review, the patient was found to have perforation at the inferior limbus with prolapse of iris tissue and total hyphema []. Fresh bleeding was noted from the perforation. Pressure patch was applied, and the patch was found soaked with blood within 30 minutes. An emergency evisceration was planned, but surgery could not be done because of bleeding diathesis. Prothrombin time (PT) was 23.2 sec. in test vs. 14 sec. in control with international normalized ratio (INR) of 2.15, for which blood transfusion was commenced. But, by 24 hours, there was spontaneous expulsion of intra-ocular contents with the crystalline lens found expelled out []. The hemorrhage arrested spontaneously, and the eyeball became phthisical []. Computerized tomography scan of the orbit showed a collapsed and deformed globe with absence of crystalline lens [].