Subconjunctival hemorrhage: Difference between revisions
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== | ==Background== | ||
*Bleeding of the conjunctival vessels into the subconjunctival space | |||
*Can be spontaneous or related to trauma | |||
**Spontaneous can be secondary to [[anticoagulation]], [[coagulopathy|bleeding diathesis]], etc. | |||
*If large and associated with trauma, see [[hemorrhagic chemosis]] | |||
**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== | |||
[[File:Eye hemorrhage.jpg|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 | |||
*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<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 | |||
*''Not'' significantly raised (see [[hemorrhagic chemosis]] if large amount raised) | |||
==Differential Diagnosis== | |||
{{Unilateral red eye DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis | |||
*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== | |||
*Reassurance (will generally resolve within 10-14d)<ref name="Mahmood" /> | |||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
*[[Eye Algorithm (Main)]] | *[[Eye Algorithm (Main)]] | ||
*[[ | *[[Hemorrhagic chemosis]] | ||
==External Links== | |||
==References== | |||
<References/> | |||
[[Category: | [[Category:Ophthalmology]] | ||
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
- 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.[3]
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.
- ↑ 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.