Red in the White!
๐ฆ๐๐ฏ๐ฐ๐ผ๐ป๐ท๐๐ป๐ฐ๐๐ถ๐๐ฎ๐น ๐๐ฒ๐บ๐ผ๐ฟ๐ฟ๐ต๐ฎ๐ด๐ฒโฃ
โ It is bleeding from a small blood vessel between the conjunctiva and the episcleraโฃ
โ It maybe spontaneous or following minor traumaโฃ
โ Usually unilateralโฃ
๐๐ข๐ถ๐ด๐ฆ๐ด:โฃ
โฃ
โ Direct injury/trauma to the eye (including contact lens wear)โฃ
โ Base of skull fracture/Zygoma fracture - lateral subconjunctival hemorrhageโฃ
โ Post surgical (Post Lasik/Post Cataract surgery)โฃ
โ Valsalva maneuvers - Extreme coughing, severe vomiting, sneezing, heavy lifting -โฃ
increased venous pressure - quick pressure can cause capillaries to breakโฃ
โ High blood pressureโฃ
โ Diabetesโฃ
โ Hyperlipidemiaโฃ
โ Coagulation disordersโฃ
โ Blood thinners and various drugs - eg, warfarin, aspirin and other non-steroidal anti-โฃ
inflammatory drugs (NSAIDs), steroids.โฃ
โ Acute hemorrhagic conjunctivitisโฃ
โ Atmospheric pressure changes like in deep sea divers/Aircraft altitude changesโฃ
โ Severe febrile systemic diseases : Dengue, typhoid, malariaโฃ
โฃ
๐๐ฏ ๐ช๐ฏ๐ง๐ข๐ฏ๐ต๐ด:โฃ
โ Scurvy/Vitamin C deficiencyโฃ
โ Abuseโฃ
โ Traumatic asphyxiaโฃ
โ Newborns following vaginal deliveryโฃ
โฃ
๐๐บ๐ฎ๐ฑ๐ต๐ฐ๐ฎ๐ด:โฃ
โ Usually asymptomatic, no pain and no visual complaintsโฃ
โฃ
๐๐ช๐จ๐ฏ๐ด:โฃ
โ Vision, pupil responses, ocular movements - will be normalโฃ
โฃ
โ Slit lamp examination shows bright-red discolouration initially underneath theโฃ
conjunctiva with sharply defined edgesโฃ โ More common in inferior conjunctiva but traumatic subconjunctival hemorrhages occur more commonly in the temporal conjunctivaโฃ
โ Later the bleeding may spread and change colour due to green or yellow due to hemoglobin being metabolizedโฃ
โ Usually disappears within 2 weeksโฃ
โฃ
โ Rule out ruptured globe and retrobulbar hemorrhageโฃ
โฃ
โ When posterior limit is not visualized : Associated with intracranial bleed/ orbitalโฃ
roof fracture (also associated with a black eye)โฃ
โฃ
๐๐ฏ๐ท๐ฆ๐ด๐ต๐ช๐จ๐ข๐ต๐ช๐ฐ๐ฏ๐ด:โฃ
โฃ
โ Check blood pressureโฃ
โ History of trauma - rule out other sight threatening traumatic injuriesโฃ
โ Recurrent cases - rule out underlying bleeding disorderโฃ
โฃ
๐๐ข๐ฏ๐ข๐จ๐ฆ๐ฎ๐ฆ๐ฏ๐ต:โฃ
โฃ
โ Self-limiting conditionโฃ
โ Requires no treatmentโฃ
โ Artificial tears for irritationโฃ
www.ophthalmobytes.com
Image from Rajan Eye Care Hospital
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