Subconjunctival Hemorrhage
I had come from a hospital background and although I worked with unusual cases (like the elderly man who got a coat hanger stuck in the opening of his penis) I never saw a case of subconjunctival hemorrhage until I was a visiting nurse. Frightened by its appearance, I called her primary care provider to schedule an appointment for her. That’s when I learned that the condition is quite benign.
In fact subconjunctival hemorrhages can occur spontaneously or as a result of some minor straining – the kind associated with coughing or bearing down when toileting. I’ve only seen it in the elderly and the other day was no exception.
In this elderly woman, there was no trauma but her companion, worried by the look of her eye, insisted she get it checked out. The sclera (the white part of the eye) was blood red and it extended around and under the cornea (the colored part of the eye).
There are several hallmarks of subconjunctival hemorrhage to know in order to make the diagnosis:
- There is no trauma associated with the incident
- There is no pain
- There are no vision changes
- The blood appears in the sclera – not the cornea
The patient may experience a sensation of fullness in the eye as a result of the bleed and it may “spread” over the next several days – this is nothing to be concerned about.
As mentioned above, these superficial vessels can rupture and leak blood as a result of coughing, straining, sneezing etc. The condition resolves by itself and no further evaluation is needed.
If the condition continues to reappear or bleeding occurs at other body sites, then the patient needs to be evaluated for clotting disorders or vasculitis (inflammation of blood vessels).
After examining the eye and reassuring myself that there was no trauma involved, I reassured the pleasantly confused elder and her companion that there was nothing to worry about and that the redness would resolve in several weeks.
Obviously, if there is trauma associated with the bleeding, this constitutes a medical emergency and you should be evaluated right away in the Emergency Department.
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