Article Text

Download PDFPDF
Henle fibre layer haemorrhage: clinical features and pathogenesis
  1. Caroline R Baumal1,
  2. David Sarraf2,
  3. Tara Bryant1,
  4. Wei Gui2,
  5. Nora Muakkassa1,
  6. Francesco Pichi3,
  7. Giuseppe Querques4,
  8. Netan Choudhry5,
  9. Mehmet Yasin Teke6,
  10. Andrea Govetto7,
  11. Alessandro Invernizzi8,
  12. Dean Eliott9,
  13. Alain Gaudric10,
  14. Eduardo Cunha de Souza11,
  15. Jonathan Naysan12,
  16. Andrea Lembo3,
  17. Grace C Lee13,
  18. K Bailey Freund14
  1. 1 Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
  2. 2 Retina Department, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA
  3. 3 University Eye Clinic, San Giuseppe Hospital, Milan, Italy
  4. 4 Ophthalmology, Ospedale San Raffaele, Milano, Italy
  5. 5 Vitreoretinal Surgery, Herzig Eye Institute, Toronto, Ontario, Canada
  6. 6 Department of Ophthalmology, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
  7. 7 Retina Department, Jules Stein Eye Institute, Los Angeles, California, USA
  8. 8 Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Milan, Italy
  9. 9 Retina Department, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  10. 10 Department of Ophthalmology, Lariboisière Hospital, University of Paris 7 Denis Diderot, Paris, France
  11. 11 Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
  12. 12 Ophthalmology, North Shore-Long Island Jewish, Great Neck, New York, USA
  13. 13 Department of Ophthalmology, Kaiser Permanente, Woodland Hills, California, USA
  14. 14 Retina Department, Vitreous Retina Macula Consultants of New York, New York, New York, USA
  1. Correspondence to Dr Caroline R Baumal, Ophthalmology, New England Eye Center, Boston, MA 02111, USA; cbaumal{at}


Background To describe the clinical presentation and characteristic imaging features of deep retinal haemorrhages primarily located in the Henle fibre layer (HFL) of the macula. The spectrum of aetiologies and a comprehensive theory of pathogenesis are presented.

Methods This is a retrospective, multicentre case series evaluating eyes with retinal haemorrhage in HFL. Clinical features, underlying aetiology, systemic and ocular risk factors, visual acuity, and multimodal imaging including fundus photography and cross-sectional and en face optical coherence tomography (OCT) are presented.

Results Retinal haemorrhages localised to HFL in 33 eyes from 23 patients were secondary to acute blunt trauma to the head (n=2), eye (n=1) and trunk (n=1), ruptured intracranial aneurysm (Terson’s syndrome, n=3), general anaesthesia (n=1), epidural anaesthesia (n=1), hypertension with anaemia (n=1), decompression retinopathy (n=1), postvitrectomy with intraocular gas (n=1), retinal vein occlusion (n=7), myopic degeneration (n=2), macular telangiectasia type 2 (n=1), and polypoidal choroidal vasculopathy (n=1). Defining clinical features included deep retinal haemorrhage with feathery margin and petaloid pattern radiating from the fovea. OCT demonstrated characteristic hyper-reflectivity from the haemorrhage delineated by obliquely oriented fibres in the Henle layer. Spontaneous resolution of HFL haemorrhage occurred after 3 months in 15 patients with follow-up.

Conclusion The characteristic petaloid-shaped, deep intraretinal haemorrhage with a feathery margin localised to HFL is associated with various disorders. The terminology ‘Henle fiber layer hemorrhage (HH)’ is proposed to describe the clinical and OCT findings, which may result from abnormal retinal venous pressure from systemic or local retinovascular disorders affecting the deep capillary plexus or from choroidal vascular abnormalities.

  • imaging
  • retina
  • macula
  • anatomy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was funded by Research to Prevent Blindness.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board approval was obtained by coauthors according to the guidelines of their respective institutions. This study adhered to the rules of the Health Insurance Portability and Accountability Act and followed the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Only deidentified data are used in table 1. The OCT and retina deidentified images are available upon request from the contributing author.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas