Spontaneous Amsler's sign - A unique presentation.

Amsler's sign is the characteristic filiform haemorrhage and hyphaema seen in cases of Fuch's heterochromic iritis, following the needle removal during paracentesis.[1] The source of bleeding is from abnormal fragile iris vessels.[2] It commonly occurs after procedures like applanation tonometry, gonioscopy and even during pharmacological mydriasis.[1] Unusual presentations have been reported after Honan ball use, peribulbar block, and intraoperatively.[3] Six cases of spontaneous Amsler's sign without any intervention have been reported, where two of them were seen only through gonioscopy.[1] Fig. 1 shows spontaneous microscopic hyphaema during routine preoperative examination that could be attributed to trivial trauma like eye rubbing.[4]

Figure 1

(a) Spontaneous filiform haemorrhage (arrowhead) in Fuch's heterochromic iridocyclitis with stellate Keratic precipitates (arrow) and mature cataract (star). (b) Hyphaema (arrowhead) captured gonioscopically in the same patient

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