𝗦𝘂𝗯𝗰𝗼𝗻𝗷𝘂𝗻𝗰𝘁𝗶𝘃𝗮𝗹 𝗛𝗲𝗺𝗼𝗿𝗿𝗵𝗮𝗴𝗲
● It is bleeding from a small blood vessel between the conjunctiva and the episclera
● It maybe spontaneous or following minor trauma
● Usually unilateral
𝘊𝘢𝘶𝘴𝘦𝘴:
● Direct injury/trauma to the eye (including contact lens wear)
● Base of skull fracture/Zygoma fracture - lateral subconjunctival hemorrhage
● Post surgical (Post Lasik/Post Cataract surgery)
● Valsalva maneuvers - Extreme coughing, severe vomiting, sneezing, heavy lifting -
increased venous pressure - quick pressure can cause capillaries to break
● High blood pressure
● Diabetes
● Hyperlipidemia
● Coagulation disorders
● Blood thinners and various drugs - eg, warfarin, aspirin and other non-steroidal anti-
inflammatory drugs (NSAIDs), steroids.
● Acute hemorrhagic conjunctivitis
● Atmospheric pressure changes like in deep sea divers/Aircraft altitude changes
● Severe febrile systemic diseases : Dengue, typhoid, malaria
𝘐𝘯 𝘪𝘯𝘧𝘢𝘯𝘵𝘴:
● Scurvy/Vitamin C deficiency
● Abuse
● Traumatic asphyxia
● Newborns following vaginal delivery
𝘚𝘺𝘮𝘱𝘵𝘰𝘮𝘴:
● Usually asymptomatic, no pain and no visual complaints
𝘚𝘪𝘨𝘯𝘴:
● Vision, pupil responses, ocular movements - will be normal
● Slit lamp examination shows bright-red discolouration initially underneath the
conjunctiva with sharply defined edges ● More common in inferior conjunctiva but traumatic subconjunctival hemorrhages occur more commonly in the temporal conjunctiva
● Later the bleeding may spread and change colour due to green or yellow due to hemoglobin being metabolized
● Usually disappears within 2 weeks
● Rule out ruptured globe and retrobulbar hemorrhage
● When posterior limit is not visualized : Associated with intracranial bleed/ orbital
roof fracture (also associated with a black eye)
𝘐𝘯𝘷𝘦𝘴𝘵𝘪𝘨𝘢𝘵𝘪𝘰𝘯𝘴:
● Check blood pressure
● History of trauma - rule out other sight threatening traumatic injuries
● Recurrent cases - rule out underlying bleeding disorder
𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵:
● Self-limiting condition
● Requires no treatment
● Artificial tears for irritation
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