The incidence and reports of this kind of characteristic disease of the optic disc and peripapillary subretinal hemorrhage are less,it is uniformly named intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage(IHAPSH) [1]. The disease has the following clinical features: (1) adolescence; (2) Monocular onset; (3) Mild to moderate myopia; (4) titled optic disc ; (5) acute onset of disease; (6) a good visual prognosis [2]. Most patients complain of floaters, blurring of vision, or deterioration of vision. Fundus examination shows titled optic disc, disc elevate of the nasal or superior disc margin, blurred boundary, and the small and crowded optic papilla with small or missing cups. The dark-red or black-red adjacent peripapillary subretinal hemorrhage with a clear boundary around 1/3 − 2/3 of the disc margin is mostly located on the nasal side, even more on the nasal side. Or note the flame-shaped hemorrhage on the surface of the optic disc; A few cases are accompanied by vitreous hemorrhage which results in floaters, and in severe cases, the above 3 types of hemorrhage phenomena may coexist [1–3]. When the hemorrhage is located within or below the optic disc, it usually causes a blurry sensation. However, when a large amount of bleeding enters the vitreous cavity, patients may experience a sense of visual obstruction. A preliminary diagnosis can be made by considering the patient's general condition and fundus examination findings. Teng Y et al. [4] believe that patients with IHAPSH have a smaller horizontal diameter of the inner aspect of the scleral canal, optic disc area, and optic disc diameter.However, the perimeter/area ratio of the optic disc, the vertical integrated rim area (VIRA), and the rim area increase, suggesting that the inner aspect of the scleral canal is relatively smaller and the optic nerve fibers are more crowded.Nasal nerve fibers enter through a small scleral ring along a sharp angle and enter the retina, while temporal nerve fibers enter the retina at a larger angle, converging to form the optic nerve.The scleral canal is conical in shape and has a small inner opening diameter and sharp edges which leads to circulatory disorders of the optic nerve.This compression of the scleral canal is most likely to cause hemorrhage in the prelaminar region near the inner side of the canal.In the nasal side of the crowded tilted optic disc, capillaries of the peripapillary choriocapillaris, the choroidal capillaries supplying the prelaminar portion of the optic disc, and the branches of the posterior ciliary artery passing through the border tissue of Elschnig are more susceptible to stretching, torsion, and/or compression [1, 5–9].The blood-retina barrier of the optic nerve head has poor permeability at the junction between the subretinal space and the border tissue of Elschnig [9]. Hemorrhage on the optic papilla nasal can enter the subretinal space through this junction. In patients with IHAPSH, the optic disc elevation leads to a widening of the peripapillary subretinal space, making it easier for blood to enter the subretinal space. It can also enter the peripapillary retina and/or penetrate the nerve tissues in the prelaminar portion of the optic disc, reaching the optic cup and spreading to the surface of the optic disc, the superficial layers of the surrounding retina or the vitreous.If the bleeding lasts for a longer period, the hemorrhage in the optic disc and superficial retina may be absorbed. Alternatively, if the bleeding pressure is low and only reaches the subretinal space around the optic disc, it may manifest as a simple peripapillary subretinal hemorrhage.Sibony et al. [10] consider that factors such as the contraction force of the extraocular muscles and changes of intraocular pressure during eye movement, the thinning of the sclera in myopic eyes due to stretching, and the traction force of the vitreous all contribute to the vulnerability of the optic disc, leading to bleeding.Kyohei [11] reported a case of optic disc hemorrhage following mRNA COVID-19 vaccine administration. Relevant literature reports that cardiovascular events such as myocarditis and thrombosis can occur after COVID-19 vaccination, and there may be temporary changes in the circulatory dynamics, including vascular spasms [12, 13].Although most of the fundus manifestations associated with COVID-19 infection are related to abnormal coagulation mechanisms, there are still some cases with abnormal bleeding mechanisms. In this case, the combination of optic disc congestion and the circulatory dynamics changes caused by the COVID-19 infection may be one of the contributing factors to the hemorrhage.In this case, the patient had symmetrical kidney-shaped marks on the nasal side of the retina both before onset and after recovery. While pigment deposition is a possibility, it is not clear whether it is associated with the occurrence of IHAPSH. The pathophysiological mechanisms of this disease are not fully clear and need to be differentiated from other conditions such as hemorrhage caused by optic disc drusen, hemorrhage caused by tractional retinal due to vitreous detachment, Valsalva retinopathy, glaucoma optic disc hemorrhage, and peripapillary intrachoroidalcavitation.In conclusion, the relevant reports of IHAPSH are rare, even more the bilateral onset. The pathophysiological mechanisms are still unclear. IHAPSH exhibits typical fundus manifestations and has a favorable self-limiting course.