1. Subconjunctival Hemorrhage
Presentation
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:
• 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, and 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:
• 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
Although this looks serious, it is usually caused by a leak in a superficial blood vessel
from trivial rauma. Recurrent hemorrhage or evidence of other bleeding sites, however,
should prompt evaluation of a vasculitis or clotting disorder.