Subconjunctival hemorrhage
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- Localization. Eyes and appendages
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Acute: less than 2 weeks
- Skin lesion. Subcutaneous/deep: swelling
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color. Due to blood: pink, red, purple or purple
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms.
- Additional information.
Brief information
- It generally presents in the form of demarcated and flat areas of hemorrhage immediately below the ocular surface, often unilateral.
- It can range from pinpoint hemorrhages to extensive areas of bleeding that make the underlying sclera invisible.
- The condition is generally benign, with users typically asymptomatic: alarm signs such as changes in visual acuity or the presence of exudate, photophobia, foreign body sensation or headache are absent.
- In rare cases, the sclera may rupture and blood may leak and accumulate in the subconjunctival space, causing a foreign body sensation.
- They may arise spontaneously or be secondary to Valsalva maneuvers, trauma, use of contact lenses, hypertension, diabetes mellitus, hemorrhagic dyscrasias, antiplatelet or hypocoagulant therapy, topical corticosteroid therapy, ocular surgery or orbital tumor.
- The user assessment must include:
- assessment of visual acuity and eye movements
- blood pressure measurement
- evaluate the INR in patients on warfarin therapy or with recurrent subconjunctival hemorrhages
Differential diagnosis
- Acute conjunctivitis
- viral
- allergic
- bacterial
- Corneal abrasion
- Foreign body in the cornea
- Episcleritis
- Endophthalmitis
- Anterior uveitis
- Scleritis
- Acute angle-closure glaucoma
- If trauma consider: rupture of the globe and retrobulbar hematoma
Treatment
- No specific treatment is required:
- An artificial tear may be used if eye discomfort occurs.
- It usually resolves spontaneously in 1 to 2 weeks.
- Refer to ophthalmology if:
- suspected trauma to evaluate possible traumatic injuries to the eyeball with slit lamp and fluorescein
- suspected orbit involvement:
- proptosis
- decreased eye movements
- suspected corneal involvement:
- pain
- photophobia
- change in visual acuity
- recurrent subconjunctival hemorrhage or without resolution within the expected time.