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Red in the White!

𝗦𝘂𝗯𝗰𝗼𝗻𝗷𝘂𝗻𝗰𝘁𝗶𝘃𝗮𝗹 𝗛𝗲𝗺𝗼𝗿𝗿𝗵𝗮𝗴𝗲⁣

● It is bleeding from a small blood vessel between the conjunctiva and the episclera⁣

● It maybe spontaneous or following minor trauma⁣

● Usually unilateral⁣


● Direct injury/trauma to the eye (including contact lens wear)⁣

● Base of skull fracture/Zygoma fracture - lateral subconjunctival hemorrhage⁣

● Post surgical (Post Lasik/Post Cataract surgery)⁣

● Valsalva maneuvers - Extreme coughing, severe vomiting, sneezing, heavy lifting -⁣

increased venous pressure - quick pressure can cause capillaries to break⁣

● High blood pressure⁣

● Diabetes⁣

● Hyperlipidemia⁣

● Coagulation disorders⁣

● Blood thinners and various drugs - eg, warfarin, aspirin and other non-steroidal anti-⁣

inflammatory drugs (NSAIDs), steroids.⁣

● Acute hemorrhagic conjunctivitis⁣

● Atmospheric pressure changes like in deep sea divers/Aircraft altitude changes⁣

● Severe febrile systemic diseases : Dengue, typhoid, malaria⁣

𝘐𝘯 𝘪𝘯𝘧𝘢𝘯𝘵𝘴:⁣

● Scurvy/Vitamin C deficiency⁣

● Abuse⁣

● Traumatic asphyxia⁣

● Newborns following vaginal delivery⁣


● Usually asymptomatic, no pain and no visual complaints⁣


● Vision, pupil responses, ocular movements - will be normal⁣

● Slit lamp examination shows bright-red discolouration initially underneath the⁣

conjunctiva with sharply defined edges⁣ ● More common in inferior conjunctiva but traumatic subconjunctival hemorrhages occur more commonly in the temporal conjunctiva⁣

● Later the bleeding may spread and change colour due to green or yellow due to hemoglobin being metabolized⁣

● Usually disappears within 2 weeks⁣

● Rule out ruptured globe and retrobulbar hemorrhage⁣

● When posterior limit is not visualized : Associated with intracranial bleed/ orbital⁣

roof fracture (also associated with a black eye)⁣


● Check blood pressure⁣

● History of trauma - rule out other sight threatening traumatic injuries⁣

● Recurrent cases - rule out underlying bleeding disorder⁣


● Self-limiting condition⁣

● Requires no treatment⁣

● Artificial tears for irritation⁣

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