Anterior Segment Optical Coherence Tomography Findings in Corneal Blood Staining.

Dear Editor,

Corneal blood staining is a complication that usually occurs after total hyphema of prolonged duration, associated with increased intraocular pressure (IOP).1 An IOP >25 mmHg for >5 days may result in corneal blood staining. Its reported incidence is 2–11% of traumatic hyphema cases and even higher for total hyphema. Other causes include hyphema induced by intraocular surgery or bleeding in the anterior chamber due to other causes.

In cases of total hyphema, the management should aim to prevent cornea staining, as it can cause vision loss due to corneal opacity, requiring corneal transplantation.2 Very rarely, corneal blood staining can occur at a low IOP.3

Anterior segment optical coherence tomography (AS-OCT) features in corneal blood staining has been described as highly refractive particles in the stroma, infiltrated by red blood cell products.4

A 50-year-old patient with visual acuity of light perception underwent transscleral cyclophotocoagulation in the right eye for IOP of 50 mmHg, secondary to neovascular glaucoma, elsewhere. Two weeks later, he presented to us, and the central cornea showed a tan colored, circumscribed, discoid shaped, blood staining, and clear periphery [Figure 1a]. IOP was 04 mmHg. AS-OCT (Optovue, Fremont) showed normal hyperreflective tear film, homogeneous stromal haze, and loss of hyperreflectivity at Descemet's membrane (DM) level [Figure 1b]. In view of poor visual prognosis, no surgical intervention was planned. The patient was lost for follow-up. Patient consent has been obtained.

Figure 1

(a) Slit-lamp photograph of the right eye shows a central, tan colored, discoid shaped corneal blood staining. (b) Anterior segment optical coherence tomography shows homogeneous stromal haze and loss of hyper-reflectivity at the Descemet's membrane level

We report a rare case of corneal blood staining at low IOP. Clinically, it is important to recognize this entity as it can simulate anterior dislocated lens. It is also relevant to perform serial AS-OCT scans, as any loss of hyperreflectivity at DM level on AS-OCT is an indication of permanent damage to the DM–endothelial complex which can result in permanent corneal blood staining. This sign could be an indication to perform endothelial transplant to replace the damaged DM. Early presentations where the DM is still visualized on AS-OCT can be managed with anterior chamber wash. Hence, serial documentation of AS-OCT could guide the clinician in the management of hyphemas.

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