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Background/objectives: Terson Syndrome (TS) is a rare entity consisting of an intraocular hemorrhage secondary to subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (IH). This study aimed to retrospectively describe the experience of the Ophthalmology Unit of Policlinico Gemelli, Rome, in the management of TS.

Methods: Twenty-four eyes of 19 patients (10 males-53%; 9 females-47%; mean age of 44.

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We report an unusual case of pupil-involving third nerve palsy associated with Terson's syndrome that resulted in the diagnosis of a right posterior communicating artery aneurysm. Interestingly, Terson's syndrome presented with Roth spot-resembling features, accompanied by third nerve palsy in a patient without any disturbance of consciousness. To our knowledge, the association of Terson's syndrome with third nerve palsy has not been described before in the absence of radiologically diagnosed subarachnoid haemorrhage.

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Article Synopsis
  • - Terson syndrome (TS) is an eye condition linked to subarachnoid hemorrhage (SAH) that causes bleeding in the eye, leading to visual impairment, and can affect one or both eyes unevenly.
  • - A 52-year-old woman experienced TS after a right middle cerebral artery aneurysm rupture during sex, but surprisingly, she reported significant visual issues in her left eye while the right eye showed more damage.
  • - TS usually causes symptoms in both eyes, but in this case, the symptoms were predominantly found in the eye opposite to the affected hemisphere, making it an unusual presentation.
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Article Synopsis
  • Terson syndrome is marked by intraocular hemorrhage related to brain injuries, with a notable incidence of 10-40% following sub-arachnoid hemorrhage.
  • A case study of a 48-year-old woman with sub-arachnoid hemorrhage showed significant visual impairment due to vitreous hemorrhage, which improved after treating an aneurysm in a major artery.
  • Timely ophthalmic evaluations are crucial for diagnosing Terson syndrome in patients with sub-arachnoid hemorrhage, as early intervention can help prevent permanent visual loss.
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