ICD-10: H31.31

Expulsive choroidal hemorrhage, classified under ICD-10 code H31.31, is a serious ocular condition characterized by the accumulation of blood in the choroidal layer of the eye, often leading to significant visual impairment. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Expulsive choroidal hemorrhage typically occurs in the context of ocular surgery, particularly during or after procedures such as cataract extraction or glaucoma surgery. It can also arise spontaneously in patients with predisposing factors. The condition is marked by a rapid onset of symptoms and can lead to severe complications if not addressed promptly.

Signs and Symptoms

1. Visual Disturbances: Patients often report sudden changes in vision, which may include blurred vision or complete loss of vision in the affected eye. This is due to the accumulation of blood in the choroid, which interferes with the normal function of the retina[1].

2. Pain: There may be significant ocular pain, which can be acute and severe. This pain is often associated with the rapid increase in intraocular pressure and the inflammatory response triggered by the hemorrhage[1].

3. Redness of the Eye: Conjunctival injection (redness) may be observed, indicating inflammation and irritation of the ocular surface[1].

4. Photophobia: Increased sensitivity to light can occur, making it uncomfortable for patients to be in well-lit environments[1].

5. Floaters or Visual Flashes: Some patients may experience floaters or flashes of light, which are indicative of retinal involvement or irritation[1].

Patient Characteristics

Certain patient characteristics and risk factors are associated with a higher likelihood of developing expulsive choroidal hemorrhage:

• Age: Older adults are more susceptible due to age-related changes in the eye and the increased likelihood of undergoing ocular surgery[1].

• Pre-existing Eye Conditions: Patients with conditions such as high myopia, glaucoma, or previous retinal detachment are at increased risk[1].

• Systemic Conditions: Conditions that affect blood coagulation, such as hypertension or anticoagulant therapy, can predispose individuals to hemorrhagic events in the eye[1].

• Surgical History: A history of previous eye surgeries, particularly those involving the anterior segment, can increase the risk of expulsive choroidal hemorrhage[1].

• Trauma: Ocular trauma can also lead to this condition, either through direct injury or as a complication of surgical intervention[1].

Conclusion

Expulsive choroidal hemorrhage is a critical condition that requires immediate medical attention. Recognizing the signs and symptoms, along with understanding the patient characteristics that predispose individuals to this condition, is essential for healthcare providers. Early intervention can significantly impact the visual prognosis and overall outcomes for affected patients. If you suspect a patient may be experiencing this condition, prompt referral to an ophthalmologist is crucial for further evaluation and management.

Expulsive choroidal hemorrhage, classified under the ICD-10 code H31.31, is a specific condition characterized by bleeding in the choroid layer of the eye, often associated with trauma or surgical procedures. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Here’s a detailed overview:

Alternative Names for Expulsive Choroidal Hemorrhage

1. Choroidal Hemorrhage: This is a broader term that encompasses any bleeding within the choroid, not limited to the expulsive type.
2. Choroidal Bleeding: Similar to choroidal hemorrhage, this term is often used interchangeably to describe bleeding in the choroid.
3. Expulsive Hemorrhage: This term emphasizes the nature of the hemorrhage being expulsive, often occurring during or after ocular surgery.
4. Postoperative Choroidal Hemorrhage: This term is used when the hemorrhage occurs as a complication following eye surgery, particularly cataract surgery or glaucoma procedures.

Related Terms

1. Choroidal Effusion: While not the same as hemorrhage, this term refers to the accumulation of fluid in the choroid, which can sometimes precede or accompany hemorrhage.
2. Retinal Detachment: This condition can be a consequence of choroidal hemorrhage, as the bleeding may lead to separation of the retina from the underlying tissue.
3. Ocular Trauma: This term encompasses any injury to the eye that could lead to conditions like expulsive choroidal hemorrhage.
4. Hemorrhagic Choroidal Detachment: This term describes a situation where the choroid becomes detached due to bleeding, which can be a severe complication of expulsive hemorrhage.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing, coding, and discussing conditions related to the eye. Accurate terminology ensures proper treatment and management of patients experiencing complications from ocular surgeries or trauma.

In summary, the ICD-10 code H31.31 for expulsive choroidal hemorrhage is associated with various alternative names and related terms that reflect its clinical significance and implications. Familiarity with these terms can aid in effective communication within the medical community and enhance patient care.

Expulsive choroidal hemorrhage is a serious ocular condition characterized by the sudden accumulation of blood in the choroid, which is the vascular layer of the eye located between the retina and the sclera. This condition is classified under the ICD-10 code H31.31, which specifically denotes "Expulsive choroidal hemorrhage."

Clinical Description

Definition

Expulsive choroidal hemorrhage occurs when there is a rupture of the choroidal vessels, leading to bleeding into the choroidal space. This can result in significant vision loss and is often associated with surgical procedures, particularly those involving the eye, such as cataract surgery or retinal detachment repair.

Etiology

The primary causes of expulsive choroidal hemorrhage include:
- Surgical Trauma: Most commonly seen during or after ocular surgeries.
- Intraocular Pressure Changes: Sudden increases in intraocular pressure can lead to vessel rupture.
- Pre-existing Conditions: Conditions such as hypertension, diabetes, or other vascular disorders may predispose individuals to this complication.

Symptoms

Patients with expulsive choroidal hemorrhage may present with:
- Sudden vision loss or changes in vision.
- A dark spot or shadow in the visual field.
- Pain or discomfort in the affected eye.
- Possible signs of ocular inflammation.

Diagnosis

Diagnosis typically involves:
- Clinical Examination: An ophthalmologist will perform a thorough eye examination, including visual acuity tests and a fundoscopic examination to assess the extent of hemorrhage.
- Imaging Studies: Optical coherence tomography (OCT) or ultrasound may be utilized to visualize the choroidal hemorrhage and assess its impact on surrounding structures.

Management and Treatment

Immediate Care

Management of expulsive choroidal hemorrhage is urgent and may include:
- Surgical Intervention: In some cases, surgical evacuation of the hemorrhage may be necessary to restore vision and relieve pressure.
- Medical Management: Control of intraocular pressure and treatment of any underlying conditions are critical.

Prognosis

The prognosis for patients with expulsive choroidal hemorrhage varies. Early intervention can improve outcomes, but the risk of permanent vision loss remains significant, particularly if the hemorrhage is extensive or if there are delays in treatment.

Conclusion

Expulsive choroidal hemorrhage, classified under ICD-10 code H31.31, is a critical condition that requires prompt diagnosis and management to mitigate the risk of severe visual impairment. Understanding the clinical presentation, potential causes, and treatment options is essential for healthcare providers involved in ophthalmic care. Regular monitoring and follow-up are crucial for patients at risk of this condition, especially those undergoing ocular surgeries.

Expulsive choroidal hemorrhage, classified under ICD-10 code H31.31, is a serious ocular condition characterized by the sudden accumulation of blood in the choroid layer of the eye, often leading to vision loss. The diagnosis of this condition involves several criteria and clinical considerations.

Diagnostic Criteria for Expulsive Choroidal Hemorrhage

1. Clinical Presentation

• Symptoms: Patients typically present with sudden vision loss, flashes of light, or the appearance of floaters. The onset is often acute and may follow ocular surgery or trauma[1].
• Physical Examination: An ophthalmologist will conduct a thorough eye examination, which may reveal signs of hemorrhage in the posterior segment of the eye.

2. Imaging Studies

• Ultrasound: B-scan ultrasonography is commonly used to visualize the choroidal hemorrhage. It can help confirm the presence of fluid or blood in the choroidal space[1].
• Fluorescein Angiography: This imaging technique can assist in assessing the extent of the hemorrhage and its impact on the retinal and choroidal circulation[2].

3. History of Ocular Surgery or Trauma

• A significant number of cases of expulsive choroidal hemorrhage occur following surgical procedures, particularly cataract surgery or glaucoma filtration surgery. A detailed surgical history is crucial for diagnosis[1][2].

4. Exclusion of Other Conditions

• It is essential to rule out other potential causes of similar symptoms, such as retinal detachment or other types of hemorrhages. This may involve additional imaging and clinical assessments[1].

5. Risk Factors Assessment

• Identifying risk factors such as advanced age, high myopia, or pre-existing ocular conditions can aid in the diagnosis. These factors may predispose patients to expulsive choroidal hemorrhage, especially during surgical interventions[2].

Conclusion

The diagnosis of expulsive choroidal hemorrhage (ICD-10 code H31.31) relies on a combination of clinical symptoms, imaging studies, surgical history, and exclusion of other ocular conditions. Prompt recognition and diagnosis are critical, as this condition can lead to significant visual impairment if not managed appropriately. If you suspect this condition, it is essential to seek immediate evaluation by an ophthalmologist for appropriate management and intervention.

Expulsive choroidal hemorrhage, classified under ICD-10 code H31.31, is a serious ocular condition characterized by the rapid accumulation of blood in the choroidal space, often leading to significant vision loss and other complications. Understanding the standard treatment approaches for this condition is crucial for effective management and patient outcomes.

Overview of Expulsive Choroidal Hemorrhage

Expulsive choroidal hemorrhage typically occurs during or after ocular surgery, particularly cataract surgery, but can also arise from trauma or other ocular conditions. The condition is marked by a sudden increase in intraocular pressure and can lead to retinal detachment, glaucoma, or permanent vision loss if not addressed promptly[1].

Standard Treatment Approaches

1. Immediate Medical Management

• Control of Intraocular Pressure (IOP): The first step in managing expulsive choroidal hemorrhage is to lower the IOP. This can be achieved through medications such as topical beta-blockers, carbonic anhydrase inhibitors, or systemic medications like oral acetazolamide[2].

• Positioning: Patients are often advised to maintain a specific head position to facilitate drainage of the hemorrhage and reduce pressure on the retina[3].

2. Surgical Intervention

• Surgical Drainage: In cases where medical management is insufficient, surgical intervention may be necessary. This can involve procedures such as:
• Paracentesis: A needle is used to relieve pressure by draining fluid from the anterior chamber.

• Vitrectomy: This procedure involves the removal of the vitreous gel and any blood in the eye, which can help restore normal anatomy and function[4].

• Retinal Repair: If the hemorrhage has led to retinal detachment, additional surgical techniques such as scleral buckling or pneumatic retinopexy may be required to reattach the retina[5].

3. Postoperative Care and Monitoring

• Follow-Up: Regular follow-up appointments are essential to monitor the healing process and detect any complications early. This includes assessing visual acuity and performing imaging studies as needed[6].

• Patient Education: Educating patients about signs of complications, such as sudden vision changes or increased pain, is vital for timely intervention.

4. Long-Term Management

• Management of Underlying Conditions: Addressing any underlying conditions that may contribute to the risk of hemorrhage, such as hypertension or anticoagulant therapy, is crucial for preventing recurrence[7].

• Vision Rehabilitation: For patients who experience significant vision loss, referral to vision rehabilitation services may be beneficial to help them adapt to changes in vision and improve their quality of life[8].

Conclusion

The management of expulsive choroidal hemorrhage requires a multifaceted approach that includes immediate medical intervention, potential surgical procedures, and ongoing monitoring. Early recognition and treatment are critical to minimizing complications and preserving vision. As with any ocular condition, a tailored approach based on the individual patient's needs and circumstances is essential for optimal outcomes. Regular follow-up and patient education play significant roles in the long-term management of this serious condition.

For further information or specific case management strategies, consulting with an ophthalmologist or a specialist in retinal diseases is recommended.