Subconjunctival hemorrhage

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, need to maintain suspicion for occult globe rupture (obscured by hemorrhage)
• Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis workup

Clinical Features

Subconjunctival hemorrhage

Subconjunctival hemorrhage

• Painless
• No effect on vision
• May recall a history of mild trauma or valsalva
• Examination
  • Fresh red blood on a white sclera with clear borders
  • Masks the conjunctival vessels

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
    • Ocular compartment syndrome
  • 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

Management

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

See Also

• Eye Algorithm (Main)