Subconjunctival bleeding

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Subconjunctival bleeding
Other names: Subconjunctival hemorrhage, subconjunctival haemorrhage, hyposphagma
Human eye showing subconjunctival hemorrhage.jpg
Subconjunctival hemorrhage resulting in red coloration of the white of the eye.
SpecialtyOphthalmology
SymptomsRed spot over whites of the eye, little to no pain[1]
ComplicationsNone[2]
DurationTwo to three weeks[2]
TypesTraumatic, spontaneous[2]
CausesCoughing, vomiting, direct injury[2]
Risk factorsHigh blood pressure, diabetes, older age[2]
Diagnostic methodBased on the appearance[2]
Differential diagnosisOpen globe, retrobulbar hematoma, conjunctivitis, pterygium[2]
TreatmentNo specific treatment[3]
MedicationArtificial tears[2]
PrognosisGood, 10% risk of reoccurance[2]
FrequencyCommon[4]

Subconjunctival bleeding, also known as subconjunctival hemorrhage, is bleeding from a small blood vessel over the whites of the eye.[1] It results in a red spot in the white of the eye.[1] There is generally little to no pain and vision is not affected.[2][3] Typically only one eye is affected.[2]

Causes can include coughing, vomiting, heavy lifting, and direct injury including that from wearing contact lenses.[2] Risk factors include high blood pressure, diabetes, older age, blood thinners, and trauma including that from wearing contact lenses.[2] They occur in about 2% of newborns following a vaginal delivery.[2] The blood occurs between the conjunctiva and the episclera.[2] Diagnosis is largely based on the appearance.[2]

Usually no specific treatment is required and the condition improves in two to three weeks.[2] Artificial tears may be used to help with any irritation.[2] They occur relatively commonly.[4] Both sexes are affected equally.[2] Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males.[2]

Signs and symptoms

Subconjunctival bleeding is bleeding from a small blood vessel over the whites of the eye.[1] It results in one or more red spots in the white of the eye, usually noticed when looking in the mirror.[1] There is generally little to no pain and vision is not affected.[2][3] Typically only one eye is affected.[2]

A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within 2 weeks.[5]

Causes

Subconjunctival bleeding can occur without a trigger, or due to trauma, infection or bleeding disorder.[6] Mostly it occurs spontaneously, particularly in older people with more fragile blood vessels.[6]

It can be caused by head injury and trauma to the eye, or after eye surgery such as LASIK.[6][7] Other traumatic causes may arise from straining such as heavy lifting or vomiting, or from increased pressure in the chest and abdomen such as from being squeezed in a crowd.[6] Choking, or coughing may cause subconjunctival bleeding.[2] Another cause may be constipation.[2] Zygoma fracture results in lateral subconjunctival bleeding.[citation needed] Another cause is mask squeeze from diving and not equalizing mask pressure during descent.[8] Causes include atmospheric pressure changes such as those from diving deeply in water and aircraft altitude changes.[9]

Infections such as conjunctivitis can result in a subconjunctival bleed.[6] Other infections included Ebola, acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus), Leptospirosis.[citation needed]

Rarely there may be a serious cause such as a bleeding disorder or leukaemia, conditions in which the subconjunctival bleeding may be recurrent.[6]

Subconjunctival bleeding in children may be associated with scurvy (vitamin C deficiency), whooping cough, malaria, purpura,[6][10] abuse or traumatic asphyxia syndrome.[11]

Risk factors

Risk factors include high blood pressure, diabetes, older age, blood thinners, and wearing contact lenses.[2]

Diagnosis

Diagnosis is largely based on the appearance, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye.[2]

Management

Subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy.[5][6] The elective use of aspirin is typically discouraged.[6]

References

  1. 1.0 1.1 1.2 1.3 1.4 Boyd, Kierstan (23 April 2020). "What is a Subconjunctival Hemorrhage?". American Academy of Ophthalmology. Archived from the original on 11 April 2021. Retrieved 11 April 2021.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 Doshi, R; Noohani, T (January 2020). "Subconjunctival Hemorrhage". StatPearls. PMID 31869130.
  3. 3.0 3.1 3.2 Cronau, H; Kankanala, RR; Mauger, T (15 January 2010). "Diagnosis and management of red eye in primary care". American Family Physician. 81 (2): 137–44. PMID 20082509.
  4. 4.0 4.1 Gold, Daniel H.; Lewis, Richard Alan (2010). Clinical Eye Atlas. Oxford University Press. p. 82. ISBN 978-0-19-534217-8.
  5. 5.0 5.1 Graham, Robert H. (11 June 2019). "Red Eye: Background, Pathophysiology and Etiology, Epidemiology and Prognosis". emedicine.medscape.com. Archived from the original on 11 April 2021. Retrieved 11 April 2021.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Sihota, Ramanjit; Tandon, Radhika (2019). "7. Diseases of the conjunctiva". Parsons' Diseases of the Eye (23rd ed.). Elsevier. p. 142. ISBN 978-81-312-5415-8.
  7. Vajpayee, R B; Balasubramanya, R; Rani, A; Sharma, N; Titiyal, J S; Pandey, R M (June 2003). "Visual performance after interface haemorrhage during laser in situ keratomileusis". The British Journal of Ophthalmology. 87 (6): 717–719. ISSN 0007-1161. PMID 12770968.
  8. Bowman, John C.; Gossman, William (4 June 2020). "Diving Mask Squeeze". StatPearls. StatPearls Publishing.
  9. Lynch, James H.; Deaton, Travis G. (2014). "Barotrauma With Extreme Pressures in Sport: From Scuba to Skydiving". Current Sports Medicine Reports. 13 (2): 107–112. doi:10.1249/JSR.0000000000000039. ISSN 1537-8918.
  10. Rothschild, Bruce M. (19 February 2021). "Scurvy Imaging: Practice Essentials, Radiography". Archived from the original on 12 April 2021. Retrieved 12 April 2021.
  11. Spitzer S. G; Luorno J.; Noël L. P. (2005). "Isolated subconjunctival hemorrhages in nonaccidental trauma". Journal of American Association for Pediatric Ophthalmology and Strabismus. 9 (1): 53–56. doi:10.1016/j.jaapos.2004.10.003. PMID 15729281.

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