A flame hemorrhage, also known as a flame heme or a flame-shaped hemorrhage, is a type of hemorrhage, or spot of bleeding, that can be seen in the back of the eye, the retina. These hemorrhages can provide important information about a patient’s eye health as well as systemic health. This article will highlight everything you should know about flame-shaped hemorrhages in the eye.
What is a Flame Hemorrhage?
A flame-shaped hemorrhage is a specific type of hemorrhage that is found in the back of the eye, the retina. As expected, flame-shaped hemorrhages are shaped like a flame with feathery, indistinct borders thus the origin of the name.
Flame hemorrhages are found in the layer of the retina called the retinal nerve fiber layer and they originate from the superficial capillary plexus.
Flame hemorrhages can be indicative of a number of different etiologies. One of the more common etiologies is hypertensive retinopathy which is caused by uncontrolled high blood pressure.
Some other etiologies include pregnancy-induced hypertension, glaucoma, subarachnoid hemorrhages, branch retinal vein occlusions, papilledema, collagen vascular diseases, diabetic retinopathy, anemia, trauma, and various other systemic conditions.
The name of this type of hemorrhage comes from its flame-like appearance. Flame-shaped hemorrhages are characterized by a feathery outer rim and streaky look. Above is an image of a flame-shaped hemorrhage seen on a retinal scan.
How to Spot a Flame Hemorrhage
If you were to have a flame-shaped hemorrhage, it would likely be found during a dilated eye examination in which an eye care provider would examine the back of your eye, the retina.
You would not be able to see this type of hemorrhage on your own, as it is located in your own eye. Dilation or retinal imaging is an important part of a comprehensive eye examination in order to check for these types of hemorrhages.
Flame-shaped hemorrhages may be able to be photographed if the eye care provider who finds the spot has the equipment in the office that allows for retinal imaging. Otherwise, you, unfortunately, would not be able to see the spot of bleeding in your own eye.
The most important thing that you can do to “spot” or look for flame-shaped hemorrhages or spots of bleeding in the back of the eye would be to get dilated eye exams or retinal imaging. A yearly dilation or imaging is recommended to monitor for any changes in the health of the back of the eye.
What Causes a Flame Hemorrhage?
Many different things including various systemic conditions can cause flame-shaped hemorrhages. One of the more common etiologies is hypertensive retinopathy which is caused by uncontrolled high blood pressure.
Some other etiologies include pregnancy-induced hypertension, glaucoma, subarachnoid hemorrhages, branch retinal vein occlusions, papilledema, collagen vascular diseases, diabetic retinopathy, anemia, trauma, and various other systemic conditions.
If you have a history of any of these conditions, it is a good idea to get a dilated eye exam to rule out any blood vessel involvement in your retina. Regular eye exams are important for catching any bleeding in the back of the eye early so that it does not cause larger issues like vision loss later down the road.
Can You Treat a Flame Hemorrhage?
Flame-shaped hemorrhages are similar to all other forms of bleeding in the retina in that there is no simple treatment. In cases of extensive bleeding in the back of the eye, an injection called an anti-VEGF can be performed to help control leaking blood and new blood vessel growth.
In many cases, however, an injection treatment is not indicated. Many cases of bleeding in the back of the eye are just monitored with dilation or retinal imaging until the blood has resolved. The blood will likely resolve by treating the underlying cause – for example with a flame hemorrhage that is caused by high blood pressure, controlling the blood pressure with medication or diet/exercise will likely result in the bleeding going away.
Is it Permanent?
A retinal flame-shaped hemorrhage is not permanent to the retina in most cases. If identified early, most small hemorrhages in the back of the eye will resolve on their own. More extensive bleeding in the back of the eye may stick around for a longer period of time and require systemic control of high blood pressure in order to resolve
Final Notes on Flame Hemorrhages
If you are concerned about flame hemorrhages or have a history of high uncontrolled blood pressure, it would be a good idea to visit your eye care provider to have a dilated eye examination completed. If identified early, many flame hemorrhages and bleeding in the retina can resolve on their own after better blood pressure control.
Dr. Olivia Burger, O.D. is an optometrist who graduated from the Pennsylvania College of Optometry. She is pursuing a 1-year residency at the UC Berkeley School of Optometry in Vision Science in Primary Care / Contact Lens. Her optometric areas of interest include private practice, contact lenses, and optometric service organizations such as VOSH. In her free time, she enjoys live music and is a freelance concert photographer.