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Editors Selection IGR 13-3
Risk Factors: Capillary nail bed and OD hemorrhages are related
Comment by Josef Flammer on:
48366 Nail bed hemorrhage: a clinical marker of optic disc hemorrhage in patients with glaucoma, Park HY; Park SH; Oh YS et al., Archives of Ophthalmology, 2011; 129: 1299-1304
Although we have clinical experience with nailfold capillary microscopy in glaucoma patients for three decades, this study provides new and very interesting findings which were either overlooked in the past or, perhaps, the authors studied a different set of glaucoma patients. Park et al. (1990) studied the nailfold capillaries of glaucoma patients and found in 52% of glaucoma patients dilated vessels, in 35% loss of capillaries and in about 20% nail bed hemorrhages. Of great interest was the fact that nail bed hemorrhages were strongly related to the optic disk hemorrhages. Although this study needs confirmation, it reports new and important findings.
Nail bed hemorrhages were strongly related to optic disc hemorrhages
What can we conclude from this publication? (1) It supports the assumption that a vascular dysfunction is associated with glaucoma. (2) The ocular blood flow changes in glaucoma can obviously not only be secondary, but are rather a representation of a systemic vascular dysfunction. (3) There is a quantitative, but no principal difference between high and normal tension glaucoma. (4) The disk hemorrhages are unlikely a consequence of a rupture of vessels, but more likely a consequence of a barrier dysfunction.
As nailfold capillary microscopy is easily to perform and can even be done with an ophthalmoscope, it seems worthwhile to have a quick look at the nailfold capillaries in glaucoma patients, particularly in patients with optic disk hemorrhages.
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