Retinal Cavernous Hemangioma – June, 2026
History:
Patient is a 70-year-old woman who presented for floaters with retinal hemorrhages in the left eye diagnosed by her primary eye care provider. She was otherwise asymptomatic with no change in vision.
Exam:
Her best corrected visual acuity was 20/20 in the right eye (OD) and 20/25 in the left eye (OS) with normal intraocular pressure in both eyes (OU). Anterior segment examination was remarkable for pseudophakia OU. Posterior segment exam OD showed a cup to disc ratio of 0.4 with a PVD, otherwise unremarkable. OS showed CDR 0.4 with PVD. The superotemporal posterior pole showed a cluster of retinal hemorrhages (Fig 1) with no tears, holes, or detachments. Fluorescein angiography revealed hypofluorescence in the early arterial phase (Fig 2) and slow hyperfluoresence in the later venous phase (Fig 3).
Differential Diagnosis of Central Retinal Artery Occlusion:
• Retinal cavernous hemangioma
• Capillary hemangioblastoma
• Acquired vasoproliferative tumor
• Branch retinal vein occlusion
• Coats disease
Discussion:
Retinal Cavernous Hemangioma
Retinal cavernous hemangioma is a benign retinal vascular tumor composed of a collection of venous aneurysms. It is typically sporadic though may be associated with neuro-oculocutaneous syndromes. Patients are asymptomatic unless secondary vitreous hemorrhage occurs, which occurs in up to 10% of patients. It is commonly described as a “cluster of grapes” appearance of dark red, intraretinal aneurysms located along a retinal venule, often with overlying gray fibroglial tissue. The lesion is not typically associated with exudation or a feeding arteriole. Most cavernous hemangiomas do not enlarge and can be safely observed. If they cause vitreous hemorrhage, treatment with laser photocoagulation or cryotherapy can be performed. Retinal cavernous hemangiomas may be associated with similar vascular anomalies of the skin and CNS.
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References:
- Fineman, M. S. (Ed.). (2024). Retina: Color Atlas and Synopsis of Clinical Ophthalmology (4th ed.). Wolters Kluwer. Lippincott Williams & Wilkins.