Spontaneous expulsive suprachoroidal hemorrhage: a case series, taxonomy, and systematic review.

PURPOSE: Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare ophthalmic emergency characterized by rupture of the globe with extrusion of intraocular contents without a temporally related inciting ocular trauma or surgery. We present 2 new cases and conduct a systematic review to elucidate the risk factors, pathophysiology, and management. METHODS: A systematic search of PubMed, Embase, and Scopus was conducted in July 2025 by 2 independent reviewers. Cases were included if they described SESCH in human patients without inciting ocular surgery or trauma. Two new cases were presented. Cases were categorized using an epidemiologic-pathophysiologic taxonomy, including typical, infantile, lesion-related, and systemic-induced SESCH. Study quality was assessed with the Joanna Briggs Institute checklist. RESULTS: Forty-three published cases and 2 new patients (n = 45) were analyzed. Typical SESCH was the most common (n = 36). Typical SESCH is most frequently associated with glaucoma (24/29, 82.8%) and corneal pathology (6/14, 42.9%). Six patients were receiving systemic anticoagulation, and over three-quarters (17/22, 77.3%) had hypertension. Systemic-induced SESCH (n = 4) was linked to coagulopathies. Lesion-related SESCH (n = 2) involved ocular tumours. Infantile SESCH (n = 3) was associated with prematurity, congenital anomalies, or ocular dysgenesis. No patient perceived light following SESCH. Surgical management most involved evisceration (46.7%) or enucleation (37.8%). Pathophysiological mechanisms remain in debate. CONCLUSIONS: SESCH is a rare and devastating ocular condition with poor visual outcomes. Glaucoma, corneal pathology, and systemic vascular disease appear to be risk factors; interpretation is limited by the rarity of SESCH. The pathophysiology likely varies by context. Management is context dependent but generally involves removal of the diseased globe.