Clinical manifestations of eyes with peripapillary hyper-reflective ovoid mass-like structure presenting with optic disc hemorrhage as the initial onset

Objective To observe the clinical manifestations in eyes presenting with optic disc hemorrhage (DH) as the initial sign, which were found to have peripapillary hyperreflective ovoid mass-like structures (PHOMS). Methods A retrospective observational study. Ten eyes of 10 patients diagnosed with DH combined with PHOMS at the Eye Hospital of Nanjing Medical University between January 2021 and May 2025 were enrolled. There were 2 male and 8 female patients. PHOMS was bilateral in 9 patients and unilateral in 1 patient. The mean age was 24.6 ± 9.6 years (range: 12–42 years). All affected eyes underwent best-corrected visual acuity (BCVA) testing, intraocular pressure (IOP) measurement, color fundus photography, B-scan ultrasonography, optical coherence tomography (OCT), fundus autofluorescence (FAF), and fundus fluorescein angiography (FFA). Results All patients experienced an acute onset of visual symptoms. Symptoms were mild, predominantly manifesting as floaters and mild vision loss. All patients had myopia and tilted disc. Four eyes had high myopia, 4 eyes had moderate myopia and 2 eyes had mild myopia. PHOMS was detected in 10 patients presenting with DH, and PHOMS was also identified in the contralateral eye in 9 of these patients. Based on bleeding area, the hemorrhages were classified as: isolated DH (3 eyes, 30%), Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) (3 eyes, 30%), and IHAPSH with vitreous hemorrhage (4 eyes, 40%). Hemorrhage within the disc and adjacent subretinal hemorrhage were located nasally in 7 eyes, superiorly in 2 eyes, and inferiorly in 1 eye. Hemorrhage spontaneously resolved within 14 to 128 days (mean, 75.8 ± 41.2), and there were no recurrent hemorrhages. Visual acuity recovered to 1.0 in all patients after observation. Conclusion DH combined with PHOMS predominantly affects one eye in female patients. It could be classified by hemorrhage severity as isolated DH, IHAPSH, or IHAPSH combined with vitreous hemorrhage. The hemorrhagic phenomena resolved spontaneously without any specific treatment, and visual acuity recovered well.