Spontaneous Hyphema from Iris Microhemangiomatosis in an Elderly Patient with Hypertensive Crisis

Abstract

Background: Iris microhemangiomatosis is a rare vascular iris tumor, with potential severe complications such as increased intraocular pressure (IOP). We aim to describe a case report of a patient presenting with hyphema secondary to iris microhemangiomatosis triggered by excessive high blood pressure.

Case presentation: A 74-year-old woman was treated for hypertensive crisis. After her high blood pressure had been controlled and stabilized, she was discharged home. However, the same day, she complained about an acute decrease in vision in her left eye. Best corrected visual acuity was 20/20 on the right eye and 20/200 on the left eye. On biomicroscopy, a hyphema was seen. Iris neovascularization was absent, IOP and fundus examination were normal. After spontaneous resolution of the hyphema, a fluorescein angiography of the anterior segment was performed, which revealed bilateral subtle early hyperfluorescence with late staining scattered at the pupillary margin. The patient was diagnosed with iris microhemangiomatosis. During the follow-up of 24 months, the blood pressure was stable and well controlled. The patient did not experience any recurrent hemorrhage.

Discussion and conclusion: Spontaneous hyphema is the most common complication of iris vascular tumors. We report the occurrence of a spontaneous hyphema triggered by uncontrolled blood pressure in a patient with a very rare condition, i.e., iris microhemangiomatosis. In order to avoid complications of microhemangiomatosis such as uncontrolled glaucoma or recurrent bleeding requiring surgery, blood pressure should be monitored closely and controlled.

Keywords: Fluorescein angiography; High blood pressure; Hyphema; Iris microhemangiomatosis.

Fig. 1

Anterior segment photograph on initial presentation. a Hyphema in the left eye originating from the pupillary border. An iris nevus can be seen at 1 o'clock. b After pupillary dilation, the hyphema can still be seen connected to the pupillary border.

Fig. 2

Anterior segment fluorescein angiography of the left eye. Anterior segment fluorescein angiography demonstrates several tiny, pinpoint foci of hyperfluorescence (a) with leakage at the iris pupillary margin in the late phase (b). At 1 o'clock, the iris nevus presents as a hypofluorescent lesion.

Fig. 3

Anterior segment fluorescein angiography of the right eye. Fluorescein angiography showing small vascular tufts scattered at the pupillary margin (a), showing late leakage (b).