Subconjunctival hemorrhage
- Etiology / Risk Factors:
- Fragile conjunctival capillary rupture.
- Valsalva maneuvers (coughing, vomiting, straining, heavy lifting).
- Minor trauma (eye rubbing, contact lenses), HTN, anticoagulants/antiplatelets.
- Clinical Presentation:
- Painless, bright red patch sharply demarcated on bulbar conjunctiva (stops at limbus).
- Normal visual acuity (VA), intact pupillary reflex, normal extraocular movements.
- Absence of eye pain, photophobia, or discharge.
- Diagnosis:
- Clinical via penlight/slit-lamp exam.
- Fluorescein staining only if trauma suspected (r/o corneal abrasion or globe rupture).
- Workup (BP, CBC, PT/INR) indicated only if recurrent, bilateral, or systemic bleeding signs present.
- Key Differentials:
- Hyphema: Blood in anterior chamber, painful, ↓ visual acuity (requires urgent ophthalmology consult).
- Globe rupture: Blunt/penetrating trauma, teardrop pupil, flat anterior chamber, (+) Seidel test.
- Conjunctivitis: Diffuse injection, pruritus, watery or purulent discharge.
- Management:
- First-line: Reassurance and observation (spontaneous resolution within 1–2 weeks).
- Supportive: Artificial tears for mild foreign body sensation.
- Secondary: Optimize BP, adjust supratherapeutic anticoagulation if indicated.