Subconjunctival hemorrhage: Difference between revisions
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*Clinical diagnosis | *Clinical diagnosis | ||
*Consider fluorescein staining to evaluate for corneal injury if suggested by history or if patient complains of pain<ref name="Mahmood" /> | *Consider fluorescein staining to evaluate for corneal injury if suggested by history or if patient complains of pain<ref name="Mahmood" /> | ||
*For recurrent or persistent subconjunctival hemorrhage, further evaluation, including workup for systemic hypertension, bleeding disorders, systemic and ocular malignancies, and drug side effects, is warranted. | |||
==Management== | ==Management== | ||
Revision as of 02:05, 8 August 2024
Background
- Bleeding of the conjunctival vessels into the subconjunctival space
- Can be spontaneous or related to trauma
- Spontaneous can be secondary to anticoagulation, bleeding diathesis, etc.
- If large and associated with trauma, see hemorrhagic chemosis
- Need to maintain suspicion for occult globe rupture (obscured by hemorrhage)[1]
- Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis and uncontrolled hypertension workup
Risk Factors[2]
- Ocular trauma
- Contact lens usage
- Systemic vascular diseases
- Hypertension
- Diabetes
- Arteriosclerosis
Clinical Features
- Painless
- No effect on vision
- Frequently atraumatic, although may recall a history of mild trauma or valsalva
- Examination
- Fresh red blood on a white sclera with clear borders[1]
- Masks the conjunctival vessels
- Not significantly raised (see hemorrhagic chemosis if large amount raised)
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Clinical diagnosis
- Consider fluorescein staining to evaluate for corneal injury if suggested by history or if patient complains of pain[1]
- For recurrent or persistent subconjunctival hemorrhage, further evaluation, including workup for systemic hypertension, bleeding disorders, systemic and ocular malignancies, and drug side effects, is warranted.
Management
- Reassurance (will generally resolve within 10-14d)[1]
Disposition
- Outpatient
See Also
External Links
References
- ↑ 1.0 1.1 1.2 1.3 Mahmood, Ahmed R., and Aneesh T. Narang. "Diagnosis and management of the acute red eye." Emergency medicine clinics of North America 26.1 (2008): 35-55.
- ↑ Tarlan B and Kiratli H. Subconjunctival hemorrhage: risk factors and potential indicators. Clin Ophthalmol. 2013; 7: 1163–1170. Published online 2013 Jun 12. doi: 10.2147/OPTH.S35062.