2.08 Subconjunctival Hemorrhage

agk’s Library of Common Simple Emergencies

Presentation

This condition may be spontaneous or follow a minor trauma, coughing episode, vomiting, or drinking binge. There is no pain or visual loss, but the patient may be frightened by the appearance of his eye and have some sensation of superficial fullness or discomfort. Often it is a friend or family member that insists the patient should be seen in the ED. This hemorrhage usually appears as a bright red area covering part of the sclera, but contained by conjunctiva. It may cover the whole visible globe, sparing only the cornea.

What to do:

• Look for associated trauma, or other signs of a potential bleeding disorder.
• Perform a complete eye exam that includes:
  1. visual acuity testing,
  2. inspection of conjunctival sacs,
  3. bright lighting the anterior chamber,
  4. testing extraocular movements,
  5. fluorescein staining, and
  6. funduscopic examination.
• Reassure the patient that there is no serious eye damage: explain that the blood may continue to spread, but that all the redness should resolve in two to three weeks.

What not to do:

• Don’t forget to tell the patient that the redness may spread over the next two days.
• Don’t ignore any significant finding discovered on the complete eye exam. Penetrating injuries and ruptured globes also present with a subconjunctival hemorrhage obscuring the damage beneath.

Discussion

Although this looks serious, it is usually caused by a leak in a superficial blood vessel from trivial trauma. Recurrent hemorrhage or evidence of other bleeding sites, however, should prompt evaluation of a vasculitis or clotting disorder.

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