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 [[ | *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 workup | *Bilateral and recurrent subconjunctival hemorrhage should have bleeding diathesis workup | ||
Revision as of 22:48, 1 March 2023
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 workup
Clinical Features
- 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[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]
Management
- Reassurance (will generally resolve within 10-14d)[1]