Known as a clinical feature of glaucoma, optic disc hemorrhage (ODH) refers to small, flame-like lesions that appear at the optic disc in the nerve fiber layer.* They are also often associated with an increase in intraocular pressure (IOP). 

Because of this connection, optic disc hemorrhage is seen as a risk factor for disease progression in glaucoma. “Disc hemorrhage generally indicates instability of glaucoma,” explains Donald Budenz, M.D., professor and chair of ophthalmology at the University of North Carolina at Chapel Hill.

When does optic disc hemorrhage occur?

ODH occurs in different types of glaucoma. Several studies found that disc hemorrhages were present in:

• 13.8% of participants with open-angle glaucoma (OAG), of which 8% had high-pressure glaucoma and 25% had low-pressure glaucoma
• 1.5% of patients had ocular hypertension (OHT) 
• 1% of normal-tension glaucoma (NTG)

Of note, a 13-year follow-up study found that there was a low incidence of ODH in participants with ocular hypertension alone (i.e., 0.5% per year), but the incidence of ODH doubled after developing primary open-angle glaucoma at 1.2% per year.

How is ODH diagnosed?

Disc hemorrhages (84%) were more likely to be detected on annual photographic review at a dedicated reading center than during a clinical exam and photographic review at the clinical encounter (16%). Therefore, relying on clinical exams only may be insufficient, and the feature could be missed. It is also important to note that optic disc imaging techniques are unable to detect disc hemorrhages.

Examination of an optic disc hemorrhage can be done with a high magnification convex lens and slit lamp biomicroscope to photograph the eye.

How is ODH managed?

Disc hemorrhages resolve by themselves and do not require treatment, but an initial start of or increase in medication that lowers IOP may be warranted. More research is needed to determine why disc hemorrhages occur—and why they only occur in some glaucoma patients—so that ophthalmologists can keep in mind these risk factors when providing treatment.

*Van Tassel, S. H. (2020, Apr. 2). Optic Disc Hemorrhage. EyeWiki (American Academy of Ophthalmology). https://eyewiki.aao.org/Optic_Disc_Hemorrhage

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