Hemorrhage

BASICS


DESCRIPTION


Blood that is under the conjunctiva. This can be spontaneous, associated with incidental trauma or obvious trauma, or recurrent, which may be associated with underlying systemic disease.


RISK FACTORS


Antiplatelet therapy, anticoagulant therapy, hypertension, diabetes mellitus, coughing, sneezing, emesis, straining (constipation), bleeding diathesis (thrombocytopenia, impaired clotting, coagulopathy), conjunctivitis (viral).


PATHOPHYSIOLOGY


Extravasation of blood from conjunctival blood vessels.


ETIOLOGY


Incidental or obvious trauma, blood dyscrasias, viral infection.


COMMONLY ASSOCIATED CONDITIONS


Hypertension, diabetes mellitus, blood dyscrasias.


DIAGNOSIS


HISTORY


Patient or bystander usually notes red eye. The patient presents with a painless red eye unless associated with trauma. Question the patient about nose bleeds, spontaneous/easy bruising.


PHYSICAL EXAM


Blood under and/or in the conjunctiva. If concerned about associated bleeding problems do a thorough retinal examination.


DIAGNOSTIC TESTS & INTERPRETATION


Lab


If recurrent subconjunctival hemorrhages consider workup of coagulation system.


Imaging


None, unless degree of trauma justifies this


Diagnostic Procedures/Other


If associated with trauma, a complete eye examination is necessary to rule out ocular pathology.


TREATMENT


MEDICATION


None.


ADDITIONAL TREATMENT


General Measures


Reassurance that hemorrhage will clear usually by 2 weeks.


Issues for Referral


Bleeding diathesis


Additional Therapies


If elevated subconjunctival hemorrhage adjacent to the limbus, use frequent artificial tears every 2 h and lubricating ointment at bedtime to try to prevent delle formation.


ONGOING CARE


FOLLOW-UP RECOMMENDATIONS


None unless associated ocular pathology from trauma or to monitor delle status


PROGNOSIS


Excellent


COMPLICATIONS


None


ADDITIONAL READING


• American Academy of Ophthalmology Basic and Clinical Science Course. Section 8, 2006–2007, 90–91.


• Mimura T, Usui T, Yamagami S, et al. Recent causes of subconjunctival hemorrhage. Ophthalmologica 2009;224(3):133–137.


• Ehlers JP, Shah CP, (eds). The Wills Eye Manual, 5th Ed. Philadelphia: JB Lippincott Publisher, 2008:112–113.


CODES


ICD9


372.72 Conjunctival hemorrhage


Only gold members can continue reading. Log In or Register to continue

Stay updated, free articles. Join our Telegram channel

Nov 9, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on Hemorrhage

Full access? Get Clinical Tree

Get Clinical Tree app for offline access