Ipsilateral sub-internal limiting membrane hemorrhage following tympanoplasty: A case report

Introduction: Sub-internal limiting membrane (sub-ILM) hemorrhage is an uncommon cause of acute visual loss caused by blood accumulation beneath the internal limiting membrane. It has been reported in association with retinal vascular disorders or sudden increases in venous pressure. Tympanoplasty is a frequently performed otologic procedure and is generally considered safe; ocular complications following such ear surgeries are rarely reported. Case Report: A 55-year-old woman underwent tympanoplasty under general anesthesia. Following extubation, the patient reported acute unilateral visual loss immediately after gaining consciousness. Ophthalmic examination revealed a dark coin-shaped premacular hemorrhage resembling sub-ILM hemorrhage in the eye ipsilateral to the operated ear. Findings of multimodal imaging, including optical coherence tomography and fundus autofluorescence, confirmed the diagnosis. The patient was observed without intervention and experienced complete resolution of visual symptoms, with no residual hemorrhage at 3-month follow-up. Conclusion: We report a case of unilateral sub-ILM hemorrhage occurring shortly after tympanoplasty. Although no established mechanism could be identified, the temporal relationship and ipsilateral presentation raise the possibility of a localized perioperative contribution. To our knowledge, similar cases have not been reported previously. Ophthalmic evaluation should be considered in patients who develop visual symptoms following otologic surgery.