Spontaneous Expulsive Choroidal Hemorrhage

A case of spontaneous expulsive choroidal hemorrhage is discussed clinically and histopathologically. Literature review reveals that the ten previously reported cases show similarities to the present case in that at least seven of the subjects and probably nine had glaucoma and all ten subjects had a corneal perforation. A mechanism is proposed for spontaneous expulsiva choroidal hemorrhage that emphasizes glaucoma as the pivotal mechanism because it accounts for the following: (1) bullous keratopathy that may become infected secondarily, culminating in a corneal perforation; (2) a greater decompressive force at the time of corneal perforation with resultant anterior displacement of retina and choroid; and (3) focal ischemia of the posterior ciliary arteries at the point where they enter the glove, weakening the arterial wall and making rupture more likely at the time of sudden decompression.