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Subconjunctival Haemorrhage
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The conjunctiva is a relatively loose structure and any bleeding can easily spread and appear quite alarming. Patients are, however, often asymptomatic and may only become aware of having a red eye when looking in the mirror or having it pointed out to them.

The majority of subconjunctival haemorrhages occur spontaneously without an identifiable cause, the patient occasionally complaining of a sudden “popping” feeling in the eye. It is likely that many of these patients may have had mild trauma eg eye rubbing, which has contributed to the bleed.

Subconjunctival haemorrhage: Post operative nasal subconjunctival haemorrhage in the left eye.

Occasionally subconjunctival haemorrhage, especially if recurrent, can be an indication of more serious ocular or systemic disease:

  1. Subconjunctival haemorrhage secondary to significant direct blunt or sharp injury may be a sign of globe rupture. If there is any doubt urgent referral is necessary for specialist opinion and the patient may require a conjunctival peritomy and exploration of the injured area.
  2. Recurrent subconjunctival bleeds can be associated with a transient rise in venous pressure eg coughing, vomiting, Valsalva manoeuvre or may be due to uncontrolled hypertension.
  3. Recurrent subconjunctival bleeds can also be a feature of a systemic bleeding diathesis (ask about easy bruising and epistaxis) or a sign that an individual is over anticoagulated eg high international normalised ratio (INR) with warfarin.
  4. Acute haemorrhagic conjunctivitis eg adenoviral conjunctivitis, may often have a degree of subconjunctival haemorrhage but the patient would have other associated ocular symptoms +/- lymphadenopathy.

Unless associated with a serious cause no therapy is required and the patient should simply be reassured. The area of haemorrhage usually changes to a yellow-brown colour before resolving in 10 – 12 days.

 

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Core Principles

1. Ocular Anatomy

2. Ophthalmic History

3. Measuring Visual Acuity

4. External Inspection / Eyelids

5. Everting The Eyelids

6. Anterior Segment

7. Pupillary Reflexes (and Dilatation)

8. Ocular Motility

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10. Direct Ophthalmoscopy

Ophthalmology in Practice

1. Red Eye Introduction

2. Red Eye Diagnosis

3. Visual Failure Introduction

4. Gradual Loss of Vision

5. Sudden Loss of Vision

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