Subconjunctival hemorrhage: Difference between revisions
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*Can be spontaneous or related to trauma
*Can be spontaneous or related to trauma
**Spontaneous can be secondary to [[anticoagulation]], [[coagulopathy|bleeding diathesis]], etc.
**Spontaneous can be secondary to [[anticoagulation]], [[coagulopathy|bleeding diathesis]], etc.
*If large and associated with [[ocular trauma|trauma]], need to maintain suspicion for occult [[globe rupture]] (obscured by hemorrhage)<ref name="Mahmood" />
*If large and associated with trauma, see [[hemorrhagic chemosis]]  
*Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis workup
**Need to maintain suspicion for occult [[globe rupture]] (obscured by hemorrhage)<ref name="Mahmood" />
*Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis and uncontrolled hypertension workup
 
===Risk Factors<ref>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.</ref>===
*[[Ocular trauma]]
*Contact lens usage
*Systemic vascular diseases
**[[Hypertension]]
**[[Diabetes]]
**Arteriosclerosis


==Clinical Features==
==Clinical Features==
[[File:Eye hemorrhage.jpg|thumb|Subconjunctival hemorrhage]]
[[File:Eye hemorrhage.jpg|thumb|Subconjunctival hemorrhage]]
[[File:PMC3700149 NJMS-3-152-g005.png|thumb|Subconjunctival hemorrhage]]
[[File:PMC3700149 NJMS-3-152-g005.png|thumb|Subconjunctival hemorrhage]]
[[File:PMC3884183 cop-0004-0180-g02.png|thumb|Bilateral subconjunctival hemorrhage: (a) at presentation, (b) after 5 days, and (c) complete resolution after 1 month.]]
*Painless
*Painless
*No effect on vision
*No effect on vision
*May recall a history of mild trauma or valsalva  
*Frequently atraumatic, although may recall a history of mild trauma or valsalva  
*Examination
*Examination
**Fresh red blood on a white sclera with clear borders<ref name="Mahmood">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.</ref>
**Fresh red blood on a white sclera with clear borders<ref name="Mahmood">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.</ref>
**Masks the conjunctival vessels
**Masks the conjunctival vessels
*Not significantly raised (see [[hemorrhagic chemosis]] if large amount raised)
*''Not'' significantly raised (see [[hemorrhagic chemosis]] if large amount raised)


==Differential Diagnosis==
==Differential Diagnosis==
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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.<ref>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.</ref>


==Management==
==Management==
*Reassurance (will generally resolve within 10-14d)<ref name="Mahmood" />
*Reassurance (will generally resolve within 10-14d)<ref name="Mahmood" />
==Disposition==
*Outpatient


==See Also==
==See Also==

Latest revision as of 02:06, 8 August 2024

Background

  • Bleeding of the conjunctival vessels into the subconjunctival space
  • Can be spontaneous or related to trauma
  • If large and associated with trauma, see hemorrhagic chemosis
  • Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis and uncontrolled hypertension workup

Risk Factors[2]

Clinical Features

Subconjunctival hemorrhage
Subconjunctival hemorrhage
Bilateral subconjunctival hemorrhage: (a) at presentation, (b) after 5 days, and (c) complete resolution after 1 month.
  • 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

^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.[3]

Management

  • Reassurance (will generally resolve within 10-14d)[1]

Disposition

  • Outpatient

See Also

External Links

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
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