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

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