72-year-old woman with 2 days of right-eye redness
Cataract/Anterior Segment
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of subconjunctival hemorrhage:
- Subconjunctival hemorrhage occurs when capillary rupture results in bleeding into the potential space between the conjunctiva and sclera.
- It is caused by a sudden increase in ocular venous pressure, such as from sneezing, straining, coughing, or vigorous eye rubbing.
- It is less commonly associated with hypertension, anticoagulant use, diabetes, or coagulopathies.
- Patients may have minor eye irritation but not significant pain. Visual acuity is unaffected.
What is the role of the primary care or emergency medicine physician?
- Most often, provide reassurance that this is a common, minor occurrence.
- If the patient has a history of ocular trauma, refer urgently to ophthalmology to evaluate for other ocular injuries.
- If the patient presents with significant subconjunctival hemorrhage extending 360 degrees around the cornea, refer emergently to ophthalmology to evaluate for an open globe, which requires emergent surgical repair.
- If the condition is recurrent, the primary care physician may perform a workup for an underlying bleeding disorder.
An example of when to refer emergently to ophthalmology is provided below.
What is the role of the ophthalmologist?
- Perform a slit-lamp examination.
- If ocular trauma occurred, evaluate for other eye injuries.
- Most often, reassure the patient that the condition is benign and will resolve.
What is the treatment?
No treatment is required if there are no other associated eye injuries. The condition will heal on its own in days to weeks. However, artificial tears may be used to relieve irritation.
Learn more: Ophthalmology resources for medical students