Trauma

Subconjunctival Hemorrhage

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Subconjunctival Hemorrhage, Spontaneous Subconjunctival Hemorrhage

  • Pathophysiology
  1. Bleeding from small Conjunctival vessels
  • Causes
  • Adults
  1. Minor Eye Trauma
  2. Spontaneously with increased venous pressure
    1. Coughing
    2. Sneezing
    3. Vomiting
    4. Straining
  3. Blood dyscrasia (uncommon)
    1. Warfarin
  4. Severe Hypertension
  • Causes
  • Children
  1. Traumatic in 83% of cases under age 18 years
  2. Traumatic or inflammatory in >94% of cases in age <2 years
  3. Nonaccidental Trauma (abusive Head Trauma)
    1. In non-mobile infants (esp. age <6 months), Subconjunctival Hemorrhage is highly suspicious
    2. Associated with concurrent Bruising (27%), Fractures (>15%) and Intracranial Hemorrhage (>5%)
    3. Koti (2021) J Pediatr Ophthalmol Strabismus 58(4):213-7 +PMID: 34288770 [PubMed]
  • Symptoms
  1. No Eye Pain
  2. Vision normal
  3. Pupil size and reactivity are normal
  • Precautions
  1. Exclude Globe Rupture when Subconjunctival Hemorrhage is Traumatic
    1. Consider with high velocity projectiles (e.g. grinding)
  2. Carefully evaluate diffuse Subconjunctival Hemorrhage (circumferential involving full 360 degrees)
    1. Associated with more serious Eye Trauma (e.g. periorbital Fracture, Retrobulbar Hematoma, Bleeding Disorder)
  • Labs
  1. ProTime (PT/INR)
    1. Indicated if Subconjunctival Hemorrhage occurs in a patient on Warfarin (Coumadin)
  • Management
  1. Careful exam including Vision
    1. Eye Trauma resulting in bleeding requires an intensive evaluation
    2. Confirm no signs of Globe Rupture
  2. Reassurance
  3. Cold compresses
  4. Artificial tears
  5. Referral for question of greater injury (especially if Traumatic Eye Injury)
  • Course
  1. Hemorrhage clears spontaneously in 1-2 weeks
  • References
  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21