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Updated: Dec 27 2021

Subconjunctival Hemorrhage

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  • Snapshot
    • A 25-year-old man presents to his primary care physician for "red eyes." He noticed this symptom in the morning while washing his face. He says that prior to going to sleep he believes both of his eyes were fine and denies any trauma to the eyes. Of note, he was recently prescribed contact lenses, which he began wearing a few days prior to presentation. He denies any pain or itchiness in the eyes and feels otherwise fine. He has no past medical history and only takes a multivitamin, for which he has been taking for many years. On physical exam, there is a subconjunctival hemorrhage, as shown . He is told that these findings should resolve in a few weeks and to return to clinic if the bleeding recurs.
  • Introduction
    • Overview
      • injury to the eye leading to hemorrhage beneath the conjunctiva
  • Epidemiology
    • Incidence
      • idiopathic is the most common cause
    • Risk factors
      • hypertension
      • eye trauma
      • coagulopathy
      • elevated venous pressures (e.g., coughing and Valsalva maneuvers)
      • diabetes mellitus
  • ETIOLOGY
    • Pathophysiology
      • rupture of vessels within the subconjuctiva
  • Anatomy
    • Conjunctiva
      • transparent tissue that adheres to the anterior portion of the sclera and lines the eyelids
      • divided into 2 sections
        • bulbar conjunctiva
          • covers the sclera
        • tarsal conjunctiva
          • covers the inner eyelids
  • Presentation
    • Symptoms
      • painless
      • bright red patch on sclera
  • Studies
    • Coagulation studies
      • indication
        • in patients on anticoagulants and in cases of recurrent subconjunctival hemorrhage and in patients with other signs of unexplained bleeding
  • Differential
    • Conjunctival injection
      • differentiating factors
        • diffusely in the sclera with the examiner being able to discern the vessels
  • Treatment
    • Conservative
      • observation
        • indication
          • initial management
  • Complications
    • Typically a full recovery
  • Prognosis
    • Clears within 1-2 weeks
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