Updated: 7/3/2019

Subconjunctival Hemorrhage

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https://upload.medbullets.com/topic/120496/images/subconjunctival_hemorrhage.jpg
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
  • Pathophysiology
    • rupture of vessels within the subconjuctiva
  • Prognosis
    • clears within 1-2 weeks
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

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Questions (3)
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(M2.OP.15.36) A 63-year-old man with chronic constipation presents to his primary care physician complaining of blood in his eye. He noticed that his eye was red when he awoke this morning. He denies any eye trauma, itching, burning, pain, or change in vision. His eye is shown in Figure A. What is the most appropriate next step?

QID: 104361
FIGURES:
1

Prescribe atropine drops

4%

(1/23)

2

Refer to an ophthalmologist

22%

(5/23)

3

Treat constipation, no treatment for eye condition is necessary

65%

(15/23)

4

Prescribe antibiotic drops

0%

(0/23)

5

Patch the eye to prevent further damage

4%

(1/23)

M 7 B

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(M2.OP.14.49) A 30-year-old male presents to your primary care clinic complaining of a "red eye". He denies pain, drainage, eye or eyelid surgery, or recent trauma. His medical history is significant for asthma and GERD; his only medication is ranitidine. He drinks 2-3 alcoholic beverages weekly, and denies smoking or illegal drug use. He reports recently beginning a weightlifting program. His vital signs are as follows: HR 63, BP 119/72, RR 9, and SpO2 100% on room air. Physical exam is unremarkable, with the exception of the findings seen in Figure A. What is the proper treatment for this condition?

QID: 106330
FIGURES:
1

Watchful waiting

86%

(30/35)

2

Topical antihistamine

6%

(2/35)

3

Topical acyclovir

0%

(0/35)

4

Repeated washing of eyelid with soap and water

6%

(2/35)

5

Topical acetazolamide

0%

(0/35)

M 7 E

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