Hemorrhagic ocular complications associated with the use of systemic thrombolytic agents

Ophthalmology. 1998 Mar;105(3):428-31. doi: 10.1016/S0161-6420(98)93023-8.

Abstract

Objective: This study aimed to report three patients with hemorrhagic ocular and orbital complications associated with the use of systemic thrombolytic agents.

Design: The study design was a retrospective small case series.

Participants: Three eyes of three patients were studied.

Intervention: Surgical procedures to reduce intraocular pressure or relieve optic nerve compression were performed.

Main outcome measures: Visual acuity and intraocular pressure were measured.

Results: Three patients received an intravenous thrombolytic agent on diagnosis of an acute myocardial infarction. One patient had a spontaneous suprachoroidal hemorrhage develop with secondary acute angle closure glaucoma shortly after receiving tissue plasminogen activator. Another patient had an orbital hemorrhage develop on receiving tissue plasminogen activator 4 days after an uncomplicated cataract extraction. The third patient experienced an orbital hemorrhage while receiving streptokinase 1 day after undergoing an external levator resection. Two patients suffered significant visual loss due to glaucoma or compressive optic neuropathy.

Conclusions: The onset of eye pain or visual loss after the administration of a systemic thrombolytic agent should alert the physician to the possibility of an ocular or adnexal hemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favorable visual outcome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Choroid Hemorrhage / chemically induced*
  • Choroid Hemorrhage / physiopathology
  • Choroid Hemorrhage / surgery
  • Eye Diseases / surgery
  • Female
  • Glaucoma, Angle-Closure / chemically induced
  • Glaucoma, Angle-Closure / physiopathology
  • Glaucoma, Angle-Closure / surgery
  • Humans
  • Intraocular Pressure
  • Male
  • Myocardial Infarction / drug therapy
  • Plasminogen Activators / adverse effects*
  • Plasminogen Activators / therapeutic use
  • Retrobulbar Hemorrhage / chemically induced*
  • Retrobulbar Hemorrhage / physiopathology
  • Retrobulbar Hemorrhage / surgery
  • Retrospective Studies
  • Streptokinase / adverse effects*
  • Streptokinase / therapeutic use
  • Thrombolytic Therapy / adverse effects*
  • Tissue Plasminogen Activator / adverse effects*
  • Tissue Plasminogen Activator / therapeutic use
  • Visual Acuity / physiology

Substances

  • Streptokinase
  • Plasminogen Activators
  • Tissue Plasminogen Activator