# Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage of both eyes after COVID-19 infection: a case report

## TL;DR

This case report describes a rare eye condition involving hemorrhage in both eyes of a young woman following a third COVID-19 infection.

## Contribution

The report highlights a rare occurrence of bilateral intrapapillary hemorrhage linked to recent COVID-19 infection in a patient without prior eye conditions.

## Key findings

- The patient showed intrapapillary and peripapillary subretinal hemorrhage in both eyes after a third COVID-19 infection.
- Conservative treatment led to complete resolution of hemorrhage and restored visual acuity within 5 months.
- The condition is typically associated with myopia and tilted optic discs, but this case lacked prior ocular risk factors.

## Abstract

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is commonly observed in myopia with tilted optic disc. It presents with typical features on the fundus and follows a self-limiting course. However, due to its complex etiology, clinicians sometimes lack sufficient understanding of it which can easily lead to misdiagnosis or overtreatment. In this case report, we describe a rare case of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage in both eyes.

An 18-year-old female who has no past medical history experienced sudden black shadow blocking of her right eye in the right eye for the past 2 days after a 5-day history of COVID-19 infection. The best corrected visual acuity is 0.5 in the right eye and 0.6 in the left eye. Optical coherence tomography (OCT) showed tilted optic discs in both eyes, bulged nasal optic discs, and the presence of strong reflective material under the parafoveal retina of the optic discs. Fundus fluorescein angiography (FFA) showed subretinal fluorescence occlusion above and nasolateral to the optic disc in the right eye, with hypofluorescence below the optic disc; the subretinal below the optic disc was obscured by vitreous hemorrhage; hypofluorescence was seen in the optic disc region of the left eye.COVID-19 antigen was positive. The patient was in the early stage of the third COVID-19 infection when the disease occurred. We speculate that it may be related to it. After 5 months of conservative treatment, the patient’s hemorrhage disappeared in both eyes and her best corrected visual acuity returned to normal.

Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage usually occurs in myopia with tilted optic disc. In most patients, the cause of the bleeding is unknown, but it can gradually resolve under clinical observation or conservative treatment.