Optic Disc Haemorrhage in Glaucoma: Significance and Management
Last updated: October 2026
Short answer: an optic disc haemorrhage is a small splinter or flame-shaped bleed at the disc margin, most often inferotemporal. In glaucoma it is a sign of active disease and is associated with progression. It often disappears within weeks to months, so it is easily missed. When you see one, document it, check for progression and consider lowering the target IOP.
Recognising a disc haemorrhage
- Splinter or flame-shaped, crossing or touching the disc margin
- Most often at the inferotemporal or superotemporal disc, where glaucomatous damage usually starts
- Often near an area of rim thinning or a nerve fibre layer defect
- Transient: usually resolves over weeks to months, and may recur
- Easily missed on a quick look; dilated stereoscopic examination and disc photographs help
Why it matters
- Disc haemorrhages were associated with a higher risk of developing glaucoma in OHTS and with progression in EMGT.
- They are more common in normal-tension glaucoma.
- A haemorrhage often precedes a new RNFL defect or field loss in the same area.
Exclude other causes
| Cause | Clues |
|---|---|
| Posterior vitreous detachment | Acute floaters; haemorrhage near the disc rather than in the rim |
| Disc swelling (papilloedema, NAION) | Swollen disc with multiple haemorrhages |
| Retinal vein occlusion | Haemorrhages extending away from the disc along veins |
| Diabetes, hypertension, anticoagulants | Systemic history, other retinal haemorrhages |
| Optic disc drusen | Lumpy disc margins, drusen visible on imaging |
What to do
- Document it with a photograph and a drawing.
- Review the visual field and OCT for progression, especially in the matching area.
- Check IOP control, adherence and target IOP; consider lowering the target.
- Shorten the follow-up interval.
- In an untreated glaucoma suspect, it may tip the balance towards starting treatment.
Frequently asked questions
Is a disc haemorrhage a sign of glaucoma progression?
It is a strong warning sign. Disc haemorrhages are associated with a higher risk of developing glaucoma and of progression, so they should prompt careful review and often a lower target IOP.
Where are glaucomatous disc haemorrhages usually found?
Most often at the inferotemporal disc margin, followed by the superotemporal margin.
How long does a disc haemorrhage last?
Usually weeks to a few months, which is why it is easy to miss between visits. Disc photographs help record it.
Related: target IOP, OCT reading tips and glaucoma notes.
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