H31.313 Expulsive choroidal hemorrhage, bilateral

Name of the Condition

• Expulsive Choroidal Hemorrhage, Bilateral (ICD Code: H31.313)

Summary

Expulsive choroidal hemorrhage, bilateral, is a severe form of bleeding within the choroid, the vascular layer of the eye, affecting both eyes. This condition is often associated with intraocular surgery or trauma and can lead to sudden vision loss and structural damage to both eyes, requiring prompt medical attention to manage complications and preserve visual function.

Causes

Expulsive choroidal hemorrhage typically occurs during or after intraocular procedures, such as cataract surgery, due to sudden changes in intraocular pressure. It may also result from direct trauma to both eyes, which disrupts the choroidal vasculature and causes rapid hemorrhage.

Risk Factors

• Intraocular surgery (e.g., cataract extraction)
• Severe eye trauma
• Pre-existing vascular disease (e.g., hypertension)
• Advanced age
• Use of anticoagulant medications
• Prolonged surgical time or intraoperative complications

Symptoms

• Sudden, severe vision loss in both eyes
• Eye pain or pressure
• Protrusion of intraocular contents (e.g., iris, lens)
• Hemorrhage visible in the anterior or posterior segment of both eyes
• Nausea or vomiting (due to pain)

Diagnosis

Diagnosis involves a thorough clinical examination of both eyes, including assessment of intraocular pressure and visualization of the hemorrhage. Imaging studies like B-scan ultrasonography may be used to evaluate the extent of the hemorrhage and associated structural damage.

Treatment Options

Treatment focuses on managing intraocular pressure, controlling bleeding, and addressing any surgical or traumatic causes. Interventions may include medications to reduce pressure, surgical repair of damaged structures, and close monitoring to prevent further complications. In severe cases, enucleation (removal of the eye) may be necessary.

Prognosis and Follow-Up

Prognosis depends on the severity of the hemorrhage and the timeliness of treatment. Early intervention can improve outcomes, but significant vision loss or permanent eye damage may occur. Follow-up care includes regular monitoring of visual function and intraocular pressure, as well as rehabilitation services for vision loss.

Complications

• Permanent vision loss or blindness
• Retinal detachment
• Glaucoma
• Infection
• Phthisis bulbi (shrinkage of the eye)

Lifestyle & Prevention

• Avoid activities that risk eye trauma (e.g., contact sports without protection)
• Manage vascular conditions (e.g., hypertension) with medical supervision
• Follow pre-operative instructions carefully before intraocular surgery
• Use caution with anticoagulant medications and report any eye trauma promptly

When to Seek Professional Help

Seek immediate medical attention if you experience sudden, severe vision loss, eye pain, or pressure, especially after surgery or trauma. Prompt evaluation is critical to minimize damage and improve outcomes.

Tips for Medical Coders

When coding for expulsive choroidal hemorrhage, bilateral (H31.313), ensure documentation specifies the bilateral nature of the condition. Verify that the medical record supports the diagnosis, including clinical findings and any associated procedures or trauma. Accurate coding requires clear documentation of the affected eyes and the underlying cause (e.g., surgery or trauma) to support the specificity of this code.