Suprachoroidal Hemorrhage

Suprachoroidal hemorrhage is bleeding that happens inside the eye in a very specific space. The eye wall has several layers. One layer is the sclera, which is the tough white coat. Just inside the sclera is a thin, dark, very blood-rich layer called the choroid. The tiny space between the sclera and the choroid is called the suprachoroidal space. In a suprachoroidal hemorrhage, blood suddenly leaks out of choroidal blood vessels and collects in that space. This pocket of blood pushes the choroid away from the sclera. The push can be strong. The push can be fast. The push can raise the pressure inside the eye in moments. When that happens, the person often feels very severe pain and can lose vision quickly.

Suprachoroidal hemorrhage is a sudden internal eye bleed that fills the space between the choroid and the sclera. It can happen during eye operations (like cataract, glaucoma, corneal, or retinal surgery), soon after surgery, after blunt or sharp trauma, or rarely on its own. The pooled blood pushes inward, may close off the drainage angle, can cause a dangerous rise in eye pressure (IOP), and may distort or detach the retina and choroid. People often notice abrupt, severe eye pain, rapid blurring or loss of vision, sometimes with nausea or vomiting because of the IOP spike. Doctors confirm the diagnosis by exam and B-scan ultrasound. Treatment starts right away with eye protection and medicines; if the blood does not clear or if the eye is structurally threatened, drainage surgery is performed when the clot has softened (most often about one to two weeks after the bleed, but this is tailored to the eye). The goals are to save vision, relieve pain, normalize pressure, and prevent new bleeding. EyeWikiRetina TodayAmerican Academy of Ophthalmology

This problem can occur during eye surgery, right after eye surgery, after an eye injury, or sometimes even without a clear trigger in people with fragile blood vessels or bleeding risks. The bleeding may be small and limited, or it may be large and widespread. When the bleeding is large, the choroid can swell so much that opposite sides of the choroid touch each other inside the eye. Doctors call this “kissing choroidals.” This is an emergency because the pressure can block blood flow to the retina and the optic nerve, which are the tissues that let you see.

How does it happen?

The choroid is full of blood vessels that feed the retina. If a choroidal blood vessel tears, blood can escape. A tear can happen when the pressure in the eye changes suddenly, when there is a deep drop in pressure during or after surgery, when the head or eye is hit, when a needle is placed around the eye for anesthesia, or when the blood is thin from medicines or disease. Once bleeding starts, the pocket of blood spreads in the suprachoroidal space because the space offers less resistance than the tight tissues in the choroid itself. The pocket can expand fast, and the expansion itself can rip more small vessels, which means even more bleeding. The eye pressure goes up, the front of the eye can become shallow, and the retina can be squeezed. All of this is painful and dangerous to sight.

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Types of Suprachoroidal Hemorrhage

By timing

1. Intraoperative (during surgery): The bleeding starts in the middle of an eye operation, like cataract surgery, glaucoma surgery, corneal transplant, or vitrectomy. The sudden bleeding can push tissue forward and force the surgeon to stop and close the eye quickly.

2. Early postoperative (soon after surgery): The bleeding begins hours to a few days after surgery. This often follows a sudden drop in eye pressure, cough, vomiting, straining, or a tight eye rub.

3. Late postoperative (days to weeks after surgery): The bleeding occurs later during recovery, sometimes due to wound leak, infection, or sudden pressure changes.

By cause

1. Surgical-related: Triggered by events during or around surgery, including anesthesia injections and sudden pressure shifts.
2. Traumatic: Caused by blunt or penetrating eye injury.
3. Spontaneous: Happens without obvious trauma or surgery, usually when blood vessels are fragile or the blood is thin from medicines or disease.

By extent

1. Focal (limited): Only a small area of the choroid lifts. Symptoms may be milder.
2. Diffuse or total: Large areas of the choroid lift. Pressure rises more, pain is worse, and vision risk is higher.

By apposition

1. Non-appositional: Raised choroid does not touch the opposite side.
2. Appositional (“kissing choroidals”): Opposite choroidal surfaces touch each other. This is severe and urgent.

By location

1. Anterior-predominant: Bleeding collects more in the front part of the suprachoroidal space and can make the front chamber of the eye shallow.
2. Posterior-predominant: Bleeding collects more in the back of the eye, which can threaten the macula and optic nerve more directly.

By onset speed

1. Acute (sudden): Symptoms explode in minutes with sharp pain and rapid vision drop.
2. Subacute: Symptoms build over hours to days when bleeding is slower or intermittent.

By laterality

1. Unilateral: One eye is involved.
2. Bilateral (rare): Both eyes are involved, usually in strong systemic risk settings.

By associated fluid

1. Pure hemorrhagic choroidal detachment: Only blood in the suprachoroidal space.
2. Hemorrhagic-serous mix: Blood mixed with inflammatory fluid.

By clinical stability

1. Stable: Bleeding is limited and not expanding.
2. Expanding: Bleeding continues to spread and pressure keeps rising.

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Causes

1. Complication during intraocular surgery: Surgery inside the eye can drop the eye’s pressure suddenly or tug on tissues, which can tear choroidal vessels and start bleeding.

2. Early postoperative hypotony (very low eye pressure): A leak from the surgical wound or an over-filtering glaucoma surgery can make pressure too low, and the pressure drop can pull on vessels and make them break.

3. Retrobulbar or peribulbar anesthesia injection: The needle or sudden volume of fluid around the eye can stress vessels and raise venous pressure, which can trigger bleeding inside the choroid.

4. Blunt eye trauma: A punch or ball to the eye can jolt the choroidal vessels and tear them, leading to bleeding in the suprachoroidal space.

5. Penetrating eye injury: A sharp object can directly damage choroidal vessels and cause bleeding.

6. Valsalva strain (heavy lifting, strong cough, vomiting, constipation): Sudden spikes in venous pressure can burst fragile choroidal vessels.

7. Uncontrolled high blood pressure: High pressure in the body’s vessels makes choroidal vessels more likely to tear during stress.

8. Anticoagulant medicines (like warfarin or some direct oral anticoagulants): These drugs thin the blood and make bleeding more likely and harder to stop.

9. Antiplatelet medicines (like aspirin or clopidogrel): These drugs reduce clotting by platelets and can increase the chance of bleeding.

10. Bleeding disorders (like hemophilia or severe thrombocytopenia): When the blood cannot clot well, even a small tear can produce a large bleed.

11. Advanced age: Older choroidal vessels are more fragile and can tear more easily with pressure changes.

12. High axial myopia (very long eyeball): The eye wall is thinner, and support tissue is weaker, so vessels are easier to tear.

13. Atherosclerosis and vascular disease: Stiff, diseased vessels are less flexible and more prone to break when pressure shifts suddenly.

14. Diabetes with small-vessel fragility: Long-term diabetes can make small vessels leaky and weak, which raises bleeding risk.

15. Liver disease with clotting problems: The liver makes clotting factors, and low levels mean bleeding lasts longer.

16. Kidney disease with uremic platelet dysfunction: Platelets do not work well in severe kidney disease, so bleeding risk is high.

17. Inflammatory eye disease (like severe scleritis): Inflammation weakens vessel walls and can set the stage for hemorrhage when pressure changes occur.

18. Carotid-cavernous fistula or venous congestion disorders: High venous pressure in the orbit transmits to choroidal veins and can trigger bleeding.

19. Sudden large pressure swing in glaucoma: Rapid falls or spikes in eye pressure can stress choroidal vessels and cause a tear.

20. Postoperative coughing or vomiting: After surgery, a bout of cough or vomiting can sharply raise venous pressure and precipitate bleeding in a vulnerable eye.

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Symptoms

1. Sudden severe eye pain: The eye can hurt a lot because pressure rises quickly and tissues are stretched.

2. Sudden drop in vision: Vision can blur or go dark in minutes when the choroid lifts and the retina is squeezed.

3. A “dark curtain” or shadow: People may describe a dark wall moving across their sight as the choroid detaches.

4. Nausea and vomiting: The high eye pressure and severe pain can make a person feel sick and vomit.

5. Headache or brow ache: The pain can spread to the forehead and temple on the same side as the affected eye.

6. Red, inflamed eye: The eye surface often looks red and irritated.

7. Tearing and watering: Reflex tearing is common when the eye is in pain.

8. Light sensitivity (photophobia): Bright light makes the eye more uncomfortable because the front of the eye is irritated and shallow.

9. Eye feels very hard to touch: The globe can feel rock-hard because the pressure is high (do not press the eye yourself if injury is suspected).

10. Loss of the “red reflex”: The normal reddish glow seen by doctors through the pupil can dim or vanish because rising choroid blocks light.

11. Sudden blurry halos: A shallow front chamber and corneal swelling from high pressure can cause halos around lights.

12. Floaters or dark spots: Some people notice spots or cobwebs if the bleeding or swelling affects the visual path.

13. Feeling of fullness or pressure behind the eye: The internal pressure and choroidal expansion can feel like pressure from inside.

14. Reduced depth of the front chamber (doctor finding that patients may notice as pain): The lens and iris can be pushed forward, which patients feel as pain and poor focus.

15. Worsening with bending or straining: Pain and blur can intensify when the head is lowered or when straining increases venous pressure.

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Diagnostic Tests

A note on testing: Doctors choose tests based on urgency, safety, and visibility inside the eye. If the view is blocked by blood or swelling, imaging helps a lot. If trauma is suspected, eye pressing is avoided. In a suspected open globe injury, safe handling is vital and some tests are deferred until the eye is protected.

Physical Examination

1. Focused history (timing and trigger review)
   The doctor asks when the pain and vision loss started and what the person was doing at that moment. Triggers like surgery, coughing, vomiting, lifting, or injury help point to a rapid pressure change and vessel tear. The doctor also reviews medicines like blood thinners and antiplatelet drugs.

2. Visual acuity check
   Reading the eye chart measures how much vision has dropped. A large, sudden loss fits with a fast, space-occupying bleed in the suprachoroidal space.

3. Pupil exam with RAPD check
   The doctor shines light in each eye and looks for normal constriction. A relative afferent pupillary defect (RAPD) can appear when the optic nerve or macula is under stress from high pressure and choroidal expansion.

4. External inspection and globe integrity
   The doctor checks for lid swelling, redness, abnormal shape of the eye, or signs of a wound. In trauma, protecting a possible open globe is the first priority, and any pressure on the eye is avoided.

5. Slit-lamp examination (front of the eye)
   The microscope exam looks for a shallow anterior chamber, corneal swelling from high pressure, or blood in the front (hyphema). A very shallow chamber suggests the choroid has pushed the iris-lens diaphragm forward.

6. Dilated fundus examination (if safe and possible)
   With dilation, the doctor looks at the back of the eye. A suprachoroidal hemorrhage appears as dark, dome-shaped, peripheral elevations of the choroid. When large, these elevations can touch each other (“kissing”) and hide the view of the retina. If the view is poor, imaging is used.

Manual / Bedside Tests

7. Digital palpation of intraocular pressure (only if globe is closed and safe)
   Gently comparing firmness of the two eyes can suggest a high pressure in the painful eye. This is skipped if any injury could have opened the eye wall.

8. Tonometry (Goldmann, iCare, or Tono-Pen)
   A device measures eye pressure in millimeters of mercury. Suprachoroidal hemorrhage often shows markedly elevated pressure. If the eye might be open from trauma, tonometry is delayed to avoid harm.

9. Gonioscopy (view of the drainage angle)
   A special contact lens lets the doctor see the angle where fluid drains. In a shallow anterior chamber, the angle may be closed or very narrow, which matches high pressure and forward push from the hemorrhage.

10. Seidel test for wound leak (after surgery or trauma, if safe)
    A fluorescein dye is placed on the eye surface. If aqueous fluid leaks from a wound, the dye stream looks bright under blue light. A leak suggests low pressure inside and risk for choroidal bleeding due to pressure imbalance.

Laboratory and Pathological Tests

11. Complete blood count with platelet count
    This looks for anemia and, more importantly, low platelets, which increase bleeding risk and can explain large or persistent hemorrhage.

12. Coagulation profile (PT/INR and aPTT)
    These tests measure how fast the blood clots. High INR or prolonged aPTT means the blood is too thin and bleeding can be worse or longer.

13. Liver function tests
    The liver makes clotting proteins. Poor liver function can reduce clotting and make a suprachoroidal hemorrhage more likely and more severe.

14. Renal function tests
    Kidney failure can impair platelet function and alter drug levels, which can increase bleeding risk and slow recovery.

Electrodiagnostic Tests

15. Visual evoked potential (VEP)
    This test measures electrical signals from the visual pathway in the brain after a light stimulus. If vision loss is severe and the view is blocked, VEP helps estimate whether visual pathways still conduct signals.

16. Electroretinography (ERG)
    ERG measures the retina’s electrical response to light. It can show whether the retina remains functional when the choroidal blood is pressing from outside and the view is poor.

17. Electro-oculography (EOG)
    EOG assesses the function of the retinal pigment epithelium and outer retina. It is less urgent in acute care but may help gauge outer retinal health once the eye is stable.

Imaging Tests

18. B-scan ultrasonography (ocular ultrasound)
    This is the key test when the doctor cannot see the retina. Ultrasound shows thick, smooth, dome-shaped choroidal elevations that are anchored at the vortex vein sites, with dense echoes that fit with blood. It helps distinguish a hemorrhagic choroidal detachment from a serous choroidal detachment and from a retinal detachment. It can also show whether the choroids are touching (“kissing”) and whether there is vitreous hemorrhage.

19. Ultrasound biomicroscopy (UBM)
    UBM is a high-frequency ultrasound that looks at the front structures of the eye in detail. It can show anterior suprachoroidal blood, a very shallow anterior chamber, and any ciliary body rotation that explains the high pressure.

20. Optical coherence tomography (OCT)
    OCT uses light to create cross-section images. OCT can map the contour of the choroid and retina when the media are clear enough, confirm choroidal lifting, and check for macular changes due to pressure or fluid shift. In limited, non-acute cases with a clear view, OCT is helpful for follow-up.

Non-pharmacological treatments (therapies & other measures)

These are supportive actions your ophthalmologist may recommend in addition to medications. They do not replace medical or surgical care, but they help lower risk of re-bleeding, protect the eye, and improve comfort.

1. Protective eye shield and rest
   Wearing a rigid shield and limiting activity protect the eye from bumps and accidental pressure. Rest reduces sudden pressure spikes inside the eye.

2. Head-of-bed elevation
   Sleeping or resting with your head raised helps the blood settle and reduces congestion around the eye.

3. Strict “no strain” routine
   Avoid heavy lifting, bending with your head down, forceful nose blowing, or tight collar/neck postures. These actions raise venous pressure and can worsen bleeding risk.

4. Cough and sneeze control
   If you must sneeze, keep your mouth open. Treat cough triggers (humidified air, avoiding smoke). Less Valsalva means fewer spikes in IOP.

5. Nausea control habits
   Small, bland meals, hydration, and avoiding triggers can limit vomiting—another source of sudden eye-pressure surges.

6. Bowel routine without straining
   High-fiber diet, fluids, and scheduled bathroom time help avoid straining. (Your doctor may add stool softeners if needed.)

7. Blood-pressure awareness
   Home BP monitoring and calm routines (slow breathing, short walks as allowed) help keep BP stable; sudden surges can stress fragile choroidal vessels.

8. Medication review (doctor-supervised)
   Your eye and medical teams coordinate around blood thinners or antiplatelet drugs. Never stop these on your own; changes are individualized to balance eye safety and overall health. American Academy of Ophthalmology

9. Posture coaching
   Move from lying to sitting to standing slowly, supporting yourself to avoid rapid systemic pressure changes and dizziness.

10. Protective home setup
    Good lighting, clear pathways, and grab bars minimize falls and eye trauma during recovery.

11. Avoid eye rubbing
    Rubbing can mechanically stress the globe and disturb wounds or fragile tissue.

12. Follow-up and monitoring
    Keeping all visits allows your doctor to track liquefaction on B-scan ultrasound, check pressure, and adjust plans (including timing for drainage). American Academy of Ophthalmology

13. Temperature moderation
    Avoid very hot baths/saunas early on; heat can dilate blood vessels and theoretically worsen congestion.

14. Sleep on the recommended side
    Your doctor may suggest a sleep position to reduce dependent congestion based on where the hemorrhage sits.

15. Gentle, approved activity
    If permitted, short, calm walks can support overall health without strain; avoid vigorous exercise until cleared.

16. Eye-drop technique training
    Using drops correctly (without touching the tip to the eye) ensures the medications work and prevents infection.

17. Stress reduction and breathing
    Simple breathing exercises lower sympathetic surges that can raise BP and IOP indirectly.

18. Infection avoidance
    Clean hands, no swimming, no dusty or smoky environments during early healing to protect surgical wounds.

19. Sun and wind protection
    Sunglasses and shields reduce irritation and reflex squeezing or tearing.

20. Emergency plan
    Know the urgent symptoms (sudden severe pain, vision blackout, halos with vomiting) and how to reach your surgeon immediately.

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Drug treatments

Doses and timing vary by patient. These examples show typical choices and purposes. Always follow your ophthalmologist’s exact instructions.

1. Topical corticosteroid (e.g., prednisolone acetate 1%)
   Class: Anti-inflammatory steroid. Typical use: 1 drop every 1–2 hours at first, then taper. When: Immediately after diagnosis/surgery as directed. Purpose: Calm intraocular inflammation. Mechanism: Blocks inflammatory pathways to reduce vascular permeability and pain. Side effects: Temporary rise in IOP, delayed wound healing, rare infection risk. EyeWiki

2. Cycloplegic/mydriatic (e.g., atropine 1% or cyclopentolate)
   Class: Anticholinergic. Dose: 1 drop once or twice daily (varies). When: Early, to relieve ciliary spasm. Purpose: Pain relief and stabilization of the uveal tissues. Mechanism: Paralyzes ciliary muscle, deepens anterior chamber. Side effects: Blurred near vision, light sensitivity, rare systemic effects in children. EyeWiki

3. Topical beta-blocker (e.g., timolol 0.5%)
   Class: Aqueous suppressor for IOP reduction. Dose: 1 drop twice daily. When: If IOP is elevated. Purpose: Lower eye pressure. Mechanism: Reduces aqueous humor production. Side effects: Can slow heart rate or worsen asthma/COPD—tell your doctor about heart/lung history.

4. Topical alpha-agonist (e.g., brimonidine 0.2%)
   Class: Aqueous suppressor/uveoscleral outflow enhancer. Dose: Usually 3× daily. Purpose: Lower IOP. Mechanism: Decreases production and increases outflow. Side effects: Dry mouth, fatigue, allergy in some patients.

5. Topical carbonic anhydrase inhibitor (e.g., dorzolamide 2%)
   Class: Aqueous suppressor. Dose: Usually 3× daily. Purpose: Lower IOP. Mechanism: Inhibits carbonic anhydrase in ciliary body to reduce fluid formation. Side effects: Stinging, bitter taste; avoid if severe sulfa allergy.

6. Systemic carbonic anhydrase inhibitor (e.g., acetazolamide)
   Class: Oral/IV IOP-lowering agent. Dose: Commonly 250 mg by mouth 2–4× daily or 500 mg IV in acute settings (doctor-selected). Purpose: Rapid pressure reduction. Mechanism: Systemic carbonic anhydrase inhibition lowers aqueous production. Side effects: Tingling, frequent urination, metabolic acidosis, kidney stones; avoid in certain kidney conditions and some sulfa allergies. American Academy of Ophthalmology

7. Hyperosmotic agent (e.g., IV mannitol 20%)
   Class: Osmotic diuretic for IOP crises. Dose: Often 1–2 g/kg IV over 30–60 min (specialist-guided). Purpose: Quickly draw fluid out of the eye to lower pressure. Mechanism: Osmotic gradient shifts water from eye and brain into bloodstream. Side effects: Dehydration, electrolyte shifts, heart failure risk—used with caution and monitoring. American Academy of Ophthalmology

8. Antiemetics and analgesics (e.g., ondansetron; acetaminophen)
   Class: Antiemetic; non-NSAID pain relief. Dose: As prescribed. Purpose: Prevent vomiting/straining and control pain without increasing bleeding risk. Mechanism: Reduce triggers that spike IOP; avoid NSAIDs if bleeding risk is a concern. Side effects: Constipation or headache (antiemetics); liver safety with acetaminophen at high doses.

9. Systemic or local hemostasis support (physician-directed)
   Class: Vitamin K, prothrombin complex concentrate (PCC), or other reversal agents when appropriate for warfarin or DOACs; individualized with the medical team. Purpose: Reduce ongoing bleeding risk when safe. Mechanism: Restores clotting capacity. Side effects: Thrombosis risk—requires careful risk–benefit with cardiology/medicine. American Academy of Ophthalmology

10. Antiglaucoma combinations (as needed)
    Class: Fixed-dose combos (e.g., timolol/dorzolamide). Purpose: Multi-mechanism pressure reduction when single agents are insufficient. Mechanism: Dual aqueous suppression; simplifies regimens. Side effects: Combined from components.

Clinicians individualize what to start, what to avoid, and when to taper, based on pressure, pain, surgical status, and overall health.

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Dietary “molecular” supplements

No supplement treats a suprachoroidal hemorrhage. Diet and supplements can support general vascular and eye health, but they do not replace medical or surgical care. Always discuss supplements with your doctor—some can increase bleeding risk or interact with blood thinners.

1. Vitamin C (≈500 mg/day)
   Supports collagen and capillary integrity; antioxidant effects. Mechanism: cofactor for collagen enzymes and free-radical control.

2. Lutein + Zeaxanthin (AREDS2-style: ~10 mg + 2 mg/day)
   Macular pigments that support retinal health; antioxidant/blue-light filtering. Mechanism: concentrates in macula to quench oxidative stress.

3. Zinc (≈8–11 mg/day total from diet/supplement)
   Cofactor for many enzymes in retinal metabolism; helps antioxidant systems. Do not exceed safe limits; high zinc can cause copper deficiency.

4. Copper (≈0.9–1.5 mg/day)
   Balances zinc supplementation; cofactor for enzymes in connective tissue and blood formation.

5. Vitamin A (aim for RDA from diet; supplement only if deficient)
   Supports photoreceptor function; fat-soluble, so avoid excess.

6. B-complex (at RDA levels)
   Supports cellular energy pathways; can help overall recovery when nutrition is marginal.

7. Magnesium (≈200–400 mg/day, diet-first)
   Involved in vascular tone and nerve function; excess can cause diarrhea or interact with meds.

8. Omega-3 fatty acids (≈1 g/day EPA+DHA from food; supplement only if approved)
   General cardiovascular support. Caution: omega-3s can have mild antiplatelet effects—ask your surgeon before use around eye surgery/bleeding.

9. Vitamin K (dietary greens rather than pills unless your doctor advises)
   Crucial for clotting proteins. Major caution if on warfarin/DOACs—keep intake consistent and physician-supervised.

10. Bilberry/anthocyanins (quality-controlled, if used at all)
    Plant antioxidants; evidence is general, not specific to SCH. Use only as an adjunct, not a treatment.

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Immunity boosters,” “regenerative,” or “stem-cell drugs” for SCH

There are no approved “immunity-booster,” regenerative, or stem-cell medicines to treat a suprachoroidal hemorrhage. SCH is a mechanical and vascular problem—blood collects where it should not, raising pressure and threatening retinal structure. The proven path is prompt protection, pressure control, inflammation control, and, when indicated, well-timed surgical drainage. Using unproven “regenerative” or stem-cell products for SCH could be unsafe and delay effective care. If you’ve heard claims to the contrary, please discuss them with your retina specialist; they can review current evidence and any legitimate clinical trials, if relevant. Retina TodayAmerican Academy of Ophthalmology

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Surgeries

1. Urgent wound closure and anterior chamber re-formation (for intraoperative/acute SCH)
   What happens: If bleeding starts during surgery, the surgeon closes all incisions quickly, may inject viscoelastic or air to deepen the front of the eye and tamponade bleeding, and stabilizes pressure.
   Why: Tamponade limits ongoing hemorrhage and protects intraocular tissues, reducing the chance of expulsive loss of contents. CRSToday

2. Delayed posterior sclerotomy drainage (the classic “choroidal tap”)
   What happens: After ultrasound shows the clot is liquefying (commonly 7–14 days), the surgeon makes small, carefully placed full-thickness sclerotomies over the area of greatest blood to gently drain the suprachoroidal space.
   Why: To relieve appositional/kissing choroidals, lower pressure, ease pain, and allow the retina to re-expand. Timing is individualized to reduce re-bleed risk. PMC+1Moran CORE

3. Pars plana vitrectomy (often combined with drainage)
   What happens: Through tiny ports, the surgeon removes vitreous gel, addresses associated retinal detachment if present, and may use gas or oil tamponade.
   Why: To manage traction, repair tears, and stabilize the posterior segment when SCH coexists with retinal pathology. Retina Today

4. Transconjunctival trocar drainage approach
   What happens: Some surgeons use valved trocars for controlled drainage.
   Why: Offers minimally invasive access and controlled egress when anatomy and surgeon preference allow. EyeWiki

5. Secondary procedures (e.g., lens or wound revision, silicone oil tamponade)
   What happens: If the original surgery was disrupted (for example, during cataract surgery), the surgeon may later revise the wound or the lens position and use internal tamponade as needed.
   Why: To restore normal anatomy and support the retina through healing. CRSToday

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Prevent suprachoroidal hemorrhage

1. Thorough pre-op planning with your surgeon, including a personalized plan for any blood thinners (never stop them without medical guidance).

2. Control glaucoma and IOP as advised before and after surgery.

3. Avoid severe hypotony after surgery by following drop instructions and shield use; report leaking or very soft eye feelings.

4. Manage blood pressure steadily (no big spikes).

5. Treat chronic cough, allergies, and reflux to reduce Valsalva.

6. No straining: fiber, hydration, and stool habits to avoid constipation.

7. Protect your eye from trauma—use shields and safety glasses when advised.

8. Keep follow-ups so ultrasound/pressure checks can catch problems early.

9. Understand your personal risk factors (age, glaucoma, axial length, prior surgery) and discuss them openly with your surgeon. PMC

10. Choose accredited surgical settings and experienced teams; meticulous technique and quick intraoperative response lower risk. American Academy of Ophthalmology

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When to see a doctor—urgent vs. routine

• Call your eye surgeon immediately (same day, emergency) if you have: sudden severe eye pain, rapid vision loss or a dark curtain, nausea/vomiting with eye pain, bulging or rock-hard eye, new halos with headache, fresh trauma, or worsening pain after recent eye surgery.

• Routine contact: Any new blur, mild ache, or visual changes after recent surgery should be reported; your surgeon will decide if you need to be seen urgently.

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Foods to favor—and to avoid

Diet won’t remove blood from the suprachoroidal space, but it helps your overall vascular health and recovery.

Eat more of:

1. Leafy greens (spinach, kale) for vitamin K (keep intake consistent if on warfarin).

2. Colorful veggies (peppers, carrots) for antioxidants.

3. Citrus and berries for vitamin C and anthocyanins.

4. Tomatoes and watermelon (lycopene).

5. Eggs and corn (lutein/zeaxanthin).

6. Legumes and nuts for magnesium and B vitamins.

7. Whole grains for steady energy and fiber (prevents straining).

8. Lean proteins (fish, poultry, tofu) for repair.

9. Low-fat dairy or fortified alternatives for vitamin A precursors.

10. Plenty of water for hydration.

Limit or avoid (especially around surgery or bleeding):

1. Alcohol excess (can raise BP and impair healing).

2. High-salt foods (blood pressure spikes).

3. Very spicy or reflux-triggering foods if they provoke coughing.

4. Energy drinks/high caffeine that trigger BP surges.

5. Ultra-processed snacks (low nutrient density).

6. Large heavy meals that worsen nausea.

7. High-dose fish-oil or ginkgo supplements without approval (bleeding risk).

8. Unregulated “blood-thinning” herbal mixes.

9. Mega-dose vitamin E without indication.

10. Any new supplement started without your surgeon’s OK.

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Frequently asked questions (FAQ)

1) Can a suprachoroidal hemorrhage cause permanent vision loss?
Yes, it can if the retina is damaged or if very high pressure persists. Rapid care aims to protect the retina and optic nerve and to restore the eye’s shape and pressure promptly. AAO Journal

2) How do doctors confirm the diagnosis?
Exam findings plus B-scan ultrasound show choroidal elevation and whether the choroids are touching (“kissing”). Ultrasound also helps judge when the clot is liquefying to plan safe drainage if needed. American Academy of Ophthalmology

3) Why wait 7–14 days for drainage?
Fresh clots are jelly-like and hard to drain; they also re-bleed more easily. After about a week or two, the clot softens (“liquefies”), making drainage more effective and safer—but the exact timing depends on your eye’s ultrasound and symptoms. PMC+1

4) What are “kissing choroidals,” and why do they matter?
They’re opposing choroidal detachments touching each other inside the eye. This is a sign of severe SCH and is a common reason to consider drainage because the retina is compressed and vision is at high risk. Retina Today

5) I had cataract surgery and now have severe pain and blur. Could this be SCH?
It’s uncommon, but severe sudden pain and blur after eye surgery is an emergency. Only an exam can tell—call your surgeon immediately. PMC

6) Do blood thinners always have to be stopped?
Not always. The plan is individualized with your eye surgeon and medical team (cardiology, internal medicine). Sometimes medicines are adjusted or bridged; sometimes they’re continued. Never change these on your own. American Academy of Ophthalmology

7) Can SCH happen without surgery or trauma?
Yes, spontaneous SCH can occur, though it’s rare. Risk factors include fragile vessels, sudden IOP changes, and systemic issues. PMC

8) Will I need a second operation?
Possibly. Many cases improve with medical care, but drainage and/or vitrectomy may be required if there is apposition, high pressure, pain, or associated retinal problems. American Academy of Ophthalmology

9) How long does recovery take?
It varies. Small hemorrhages may settle over weeks, while large ones—especially those needing surgery—may take months to stabilize. Vision outcome depends on retinal health and speed of pressure control. Retina Today

10) Can SCH recur?
Yes, if risk factors persist (e.g., new surgery, uncontrolled BP, hypotony). Good pre-op planning and careful postoperative care help reduce risk. American Academy of Ophthalmology

11) Is flying allowed?
If a gas bubble is placed during retinal surgery, flying is not allowed until your surgeon clears it. Without gas, individual factors still apply—ask your doctor.

12) Can I use my usual pain reliever?
Many surgeons prefer acetaminophen over NSAIDs when bleeding risk is high, but your doctor will guide you based on your health and medicines.

13) What warning signs mean “go to the ER now”?
New severe eye pain, sudden vision loss, nausea/vomiting with eye pain, or bulging, extremely hard eye after surgery or trauma.

14) What is the long-term outlook?
Outcomes range widely—from good recovery to significant vision loss—depending on the size of the hemorrhage, retinal involvement, speed of treatment, and underlying eye health. AAO Journal

15) Are there new technologies that help?
Modern valved trocar systems and high-resolution ultrasound guide safer drainage and surgical planning. These tools help surgeons drain more precisely and reduce complications. EyeWiki

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Last Updated: August 27, 2025.