2.08 Subconjunctival Hemorrhage
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- Look for associated trauma, or other signs of 
   a potential bleeding disorder.
- Perform a complete eye exam that includes: 
   a) visual acuity testing, 
   b) inspection of conjunctival sacs, 
   c) bright lighting the anterior chamber, 
   d) testing extraocular movements, 
   e) fluorescein staining, and 
   f) 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:
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- 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
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Although this looks serious, it is usually 
caused by a leak in a superficial blood vessel 
from trivial yrauma. Recurrent hemorrhage or 
evidence of other bleeding sites, however, 
should prompt evaluation of a vasculitis or 
clotting disorder.

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
 Longwood Information LLC 4822 Quebec St NW Wash DC
 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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