Cases of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage are uncommon and have been reported only very rarely. It commonly presents (1) monocularly, (2) with higher prevalence in myopic eyes, (3) more often in eyes with tilted discs, (4) abruptly, (5) in young age, and (6) with good visual prognosis in the affected eye [
1,
4]. Two cases of a 15-year-old male and 13-year-old female patient with myopic eyes have been previously reported in Korea in 2006 [
3]. However, the exact cause was not known [
1,
2,
4,
5]. Previous studies proposed potential pathogenic mechanisms including vitreopapillary traction, the hemorrhage of anatomically vulnerable prelaminar blood vessels in crowded optic discs, the hemodynamic effects of the Valsalva maneuver, and complications of optic disc edema [
1,
4]. Prelaminar regions have an arterial blood supply from the peripapillary choroidal arteries and posterior short ciliary arteries, whereas the venous system of the prelaminar portion drains predominately to the central retinal vein with minor contributions to the peripapillary choroidal veins [
6,
7]. The unique structure of the elevated superior and nasal margins of a tilted myopic disc might draw the retinal and choroidal tissues over and around the elevated edge. Therefore, the choroidal blood supply of the prelaminar optic nerve may lead to bleeding in patients with a tilted myopic disc, which may be spontaneous or triggered by an acute event. [
8,
9]. Likewise, in our cases, the hemorrhage formed in young patients with myopic eyes, and the bleeding may have originated from capillaries of the peripapillary choriocapillaris and branches of the posterior ciliary artery that traverse the border tissue of Elschnig between the nasal side of the optic nerve and the adjacent inner aspect of the scleral canal [
10].
In addition, the optic disc drusen can be the possible cause of subretinal hemorrhage as a result of direct mechanical compression. Superficial peripapillary vessels of small optic discs and scleral canals with optic disc drusen are vulnerable, and can be ruptured resulting in hemorrhages over the optic disc and peripapillary areas. [
11‐
15] However, in our cases, multimodal imaging including OCT did not reveal any presence of optic disc drusen. Similarly in several previous studies, presence of any optic disc drusen was not detected in any of the cases with peripapillary subretinal hemorrhage [
1‐
4].