Subconjunctival bleeding

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Subconjunctival bleeding
Other namesSubconjunctival hemorrhage, hyposphagma
SubconjunctivalHaemorrhage.jpeg
Subconjunctival hemorrhage resulting in red coloration of the white of the eye
Specialty Ophthalmology, Optometry
Symptoms Red spot over whites of the eye, little to no pain
Complications None
DurationOne to two weeks
TypesTraumatic, spontaneous
CausesCoughing, vomiting, direct injury
Risk factors High blood pressure, diabetes, older age
Diagnostic method Based on appearance
Differential diagnosis Open globe, retrobulbar hematoma, conjunctivitis, pterygium
TreatmentNo specific treatment
Medication Artificial tears
Prognosis Good, 10% risk of recurrence
FrequencyCommon

Subconjunctival bleeding, also known as subconjunctival hemorrhage or subconjunctival haemorrhage, is bleeding from a small blood vessel over the whites of the eye. 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] Generally only one eye is affected. [2]

Contents

Causes can include coughing, vomiting, heavy lifting, straining during acute constipation or the act of "bearing down" during childbirth, as these activities can increase the blood pressure in the vascular systems supplying the conjunctiva. Other causes include blunt or penetrating trauma to the eye. Risk factors include hypertension, diabetes, old age, and blood thinners. Subconjunctival bleeding occurs in about 2% of newborns following a vaginal delivery. The blood accumulates between the conjunctiva and the episclera. Diagnosis is generally based on the appearance of the conjunctiva. [2]

The condition is relatively common, [4] and both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males. Generally no specific treatment is required and the condition resolves over two to three weeks. Artificial tears may be used to alleviate irritation. [2]

Signs and symptoms

Subconjunctival bleeding initially appears bright red underneath the transparent bulbar conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within two weeks. [5] The affected eye may feel dry, rough, or scratchy, but the condition is not usually painful.

Causes

Subconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency), [8] abuse or traumatic asphyxia syndrome. [9]

Diagnosis

Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. In rare cases blood may drip from the eye.

Management

A 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. [10] The elective use of aspirin is typically discouraged.

Related Research Articles

<span class="mw-page-title-main">Conjunctivitis</span> Inflammation of the eye

Conjunctivitis, also known as pink eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. The affected eye may have increased tears or be "stuck shut" in the morning. Swelling of the white part of the eye may also occur. Itching is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

<span class="mw-page-title-main">Retinopathy</span> Medical condition

Retinopathy is any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to retinal vascular disease, or damage to the retina caused by abnormal blood flow. Age-related macular degeneration is technically included under the umbrella term retinopathy but is often discussed as a separate entity. Retinopathy, or retinal vascular disease, can be broadly categorized into proliferative and non-proliferative types. Frequently, retinopathy is an ocular manifestation of systemic disease as seen in diabetes or hypertension. Diabetes is the most common cause of retinopathy in the U.S. as of 2008. Diabetic retinopathy is the leading cause of blindness in working-aged people. It accounts for about 5% of blindness worldwide and is designated a priority eye disease by the World Health Organization.

<span class="mw-page-title-main">Bleeding</span> Loss of blood escaping from the circulatory system

Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a puncture in the skin. Hypovolemia is a massive decrease in blood volume, and death by excessive loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties. The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery.

<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is the leading cause of fatal head injuries in children younger than two years. Diagnosing the syndrome has proved both challenging and contentious for medical professionals, in that objective witnesses to the initial trauma are generally unavailable. This is said to be particularly problematic when the trauma is deemed 'non accidental'. Some medical professionals propose that SBS is the result of respiratory abnormalities leading to hypoxia and swelling of the brain. The courtroom has become a forum for conflicting theories with which generally accepted medical literature has not been reconciled. Often there are no outwardly visible signs of trauma, despite the presence of severe internal brain and eye injury. Complications include seizures, visual impairment, cerebral palsy, cognitive impairment, and death.

<span class="mw-page-title-main">Nosebleed</span> Bleeding from the nose

A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blood pressure occurs. Blood may also come up the nasolacrimal duct and out from the eye.

<span class="mw-page-title-main">Intracranial hemorrhage</span> Hemorrhage, or bleeding, within the skull

Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds. More often than not it ends in a lethal outcome.

<span class="mw-page-title-main">Conjunctiva</span> Conjunctiva is Outer protective layer/covering of sclera

The conjunctiva is a thin mucous membrane that lines the inside of the eyelids and covers the sclera. It is composed of non-keratinized, stratified squamous epithelium with goblet cells, stratified columnar epithelium and stratified cuboidal epithelium. The conjunctiva is highly vascularised, with many microvessels easily accessible for imaging studies.

<span class="mw-page-title-main">Hypovolemic shock</span> Medical condition

Hypovolemic shock is a form of shock caused by severe hypovolemia. It could be the result of severe dehydration through a variety of mechanisms or blood loss. Hypovolemic shock is a medical emergency; if left untreated, the insufficient blood flow can cause damage to organs, leading to multiple organ failure.

<span class="mw-page-title-main">Epidural hematoma</span> Build-up of blood between the dura mater and skull

Epidural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull. Often there is loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Complications may include seizures.

<span class="mw-page-title-main">Eye injury</span> Physical or chemical injuries of the eye

Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is redness and pain of the affected eyes. This is not, however, universally true, as tiny metallic projectiles may cause neither symptom. Tiny metallic projectiles should be suspected when a patient reports metal on metal contact, such as with hammering a metal surface. Corneal foreign body is one of the most common preventable occupational hazard. Intraocular foreign bodies do not cause pain because of the lack of nerve endings in the vitreous humour and retina that can transmit pain sensations. As such, general or emergency department doctors should refer cases involving the posterior segment of the eye or intraocular foreign bodies to an ophthalmologist. Ideally, ointment would not be used when referring to an ophthalmologist, since it diminishes the ability to carry out a thorough eye examination.

<span class="mw-page-title-main">Red eye (medicine)</span> Eye that appears red due to illness / injury. It is a common diseases

A red eye is an eye that appears red due to illness or injury. It is usually injection and prominence of the superficial blood vessels of the conjunctiva, which may be caused by disorders of these or adjacent structures. Conjunctivitis and subconjunctival hemorrhage are two of the less serious but more common causes.

Retinal hemorrhage is a disorder of the eye in which bleeding occurs in the retina, the light sensitive tissue, located on the back wall of the eye. There are photoreceptor cells in the retina called rods and cones, which transduce light energy into nerve signals that can be processed by the brain to form visual images. Retinal hemorrhage is strongly associated with child abuse in infants and young children and often leaves such abused infants permanently blind. In older children and adults, retinal hemorrhage can be caused by several medical conditions such as hypertension, retinal vein occlusion, anemia, leukemia or diabetes.

<span class="mw-page-title-main">Hyphema</span> Hemorrhage in the front chamber of the eye

Hyphema is the medical condition of bleeding in the front (anterior) chamber of the eye between the iris and the cornea. People usually first notice a loss or decrease in vision. The eye may also appear to have a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris in the cornea. A traumatic hyphema is caused by a blow to the eye. A hyphema can also occur spontaneously.

<span class="mw-page-title-main">Intracerebral hemorrhage</span> Type of intracranial bleeding that occurs within the brain tissue itself

Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. An ICH is one kind of bleeding within the skull and one kind of stroke. Symptoms can include headache, one-sided weakness, vomiting, seizures, decreased level of consciousness, and neck stiffness. Often, symptoms get worse over time. Fever is also common.

<span class="mw-page-title-main">Cerebral contusion</span> Medical condition

Cerebral contusion, Latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries. A cerebral laceration is a similar injury except that, according to their respective definitions, the pia-arachnoid membranes are torn over the site of injury in laceration and are not torn in contusion. The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Thus treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull.

<span class="mw-page-title-main">Brain herniation</span> Potentially deadly side effect of very high pressure within the skull

Brain herniation is a potentially deadly side effect of very high pressure within the skull that occurs when a part of the brain is squeezed across structures within the skull. The brain can shift across such structures as the falx cerebri, the tentorium cerebelli, and even through the foramen magnum. Herniation can be caused by a number of factors that cause a mass effect and increase intracranial pressure (ICP): these include traumatic brain injury, intracranial hemorrhage, or brain tumor.

<span class="mw-page-title-main">Traumatic aortic rupture</span> Medical condition

Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as a result of trauma to the body. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in shock and death. Thus traumatic aortic rupture is a common killer in automotive accidents and other traumas, with up to 18% of deaths that occur in automobile collisions being related to the injury. In fact, aortic disruption due to blunt chest trauma is the second leading cause of injury death behind traumatic brain injury.

<span class="mw-page-title-main">Intraocular hemorrhage</span> Medical condition

Intraocular hemorrhage is a bleeding (hemorrhage) inside the eye. The bleeding can occur from any structure of the eye where there is a presence of vasculature or blood flow. It can bleed inside the anterior chamber, vitreous cavity, retina, choroid, suprachoroidal space, or optic disc. Intraocular hemorrhage can be subdivided depending on the location of the bleed. It may be the result of physical trauma, an uncommon side effect due to post op ocular surgery or other diseases, injuries or disorders. Severe bleeding may cause high pressures inside the eye, leading to blindness.

Sickle cell retinopathy can be defined as retinal changes due to blood vessel damage in the eye of a person with a background of sickle cell disease. It can likely progress to loss of vision in late stages due to vitreous hemorrhage or retinal detachment. Sickle cell disease is a structural red blood cell disorder leading to consequences in multiple systems. It is characterized by chronic red blood cell destruction, vascular injury, and tissue ischemia causing damage to the brain, eyes, heart, lungs, kidneys, spleen, and musculoskeletal system.

Valsalva retinopathy is a form of retinopathy due to retinal bleeding secondary to rupture of retinal vessels caused by intrathoracic or intra-abdominal pressure due to physical activities. It can occur in any person irrespective of age, gender, race or health status.

References

  1. "What is a Subconjunctival Hemorrhage?". American Academy of Ophthalmology. 3 July 2019. Retrieved 17 October 2019.
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  3. 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. Gold, Daniel H.; Lewis, Richard Alan (2010). Clinical Eye Atlas. Oxford University Press. p. 82. ISBN   978-0-19-534217-8.
  5. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.
  6. 1 2 "Subconjunctival hemorrhage". PubMed Health on the National Institutes of Health website. May 1, 2011. Archived from the original on Feb 2, 2014. Retrieved October 15, 2012.
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  8. Bruce M. Rothschild (December 17, 2008). "Scurvy". eMedicine.com . Retrieved Mar 26, 2022.
  9. 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.
  10. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.