Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage in a 9-Year-Old Girl: A Case Report.

Introduction: Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) is a syndrome associated with intrapapillary hemorrhage and peripapillary subretinal hemorrhage that commonly occurs in myopic women. There have been no reports of patients younger than 10 years. We report a case of typical IHAPSH that occurred in a 9-year-old girl in the advanced stages of myopia.

Case presentation: A 9-year-old girl presented with gradually decreasing uncorrected visual acuity in the left eye over the past year, without complaints of floaters or blurred vision. Uncorrected visual acuity was 20/16 in the right eye and approximately 20/285 in the left eye, improving to 20/16 with -4.50 diopters sphere and -0.50 diopters cylinder at 165°. Ophthalmoscopic examination revealed intrapapillary hemorrhage and nasal peripapillary subretinal hemorrhage in her left eye. The left eye had a small, tilted papilla. Fluorescein angiography showed no leakage from the papilla. The length of the ocular axis was elongated to 24.87 mm in the left, compared to 23.15 mm in the right. We diagnosed IHAPSH and decided to follow the patient. After 8 weeks, the hemorrhage was almost completely absorbed. No recurrence has been observed since then.

Conclusion: To our knowledge, this is the youngest reported case of IHAPSH. This case underscores the potential contribution of optic disc morphology and progressive myopia to IHAPSH pathogenesis and highlights the importance of considering this condition in the differential diagnosis of optic disc hemorrhage in school-aged children.