Subconjunctival hemorrhage

Question 1

Define subconjunctival hemorrhage (SCH).

Answer 1

An eye condition which occurs as a result of collection of blood in the subconjunctival space
It can occur due to rupture of conjunctival or episcleral blood vessels

Question 2

Describe the pathophysiology of SCH.

Answer 2

Subconjunctival hemorrhage results from bleeding of the conjunctival or episcleral blood vessels that subsequently leaks into the subconjunctival space

Question 3

What are the 2 classifications of SCH?

Answer 3

1. Traumatic
2. Spontaneous

Question 4

Give 4 risk factors for spontaneous SCH.

Answer 4

• Idiopathic in 50% of the cases
• Valsalva maneuvers e.g. coughing, straining and vomiting which cause a brief rise in blood pressure in veins which leads to their burst
• Systemic hypertension
• Hyperlipidemia
• Diabetes mellitus
• Bleeding disorders
• Use of anticoagulants and antiplatelets

Question 5

Give 4 risk factors for traumatic SCH.

Answer 5

• Direct trauma
• Rubbing eyes
• Ocular surgeries
• Contacts lens wearing
• Vaginal delivery may cause neonatal SCH
• Non accidental trauma if bilateral

Question 6

Give 3 signs and symptoms of SCH.

Answer 6

red eye, painless

usually patient is unaware of it until they look into a mirror or told by someone

unilateral

can be localised or diffused

temporal sides mostly affected

Question 7

What is the clinical presentation of SCH? (3)

Answer 7

Red eye, often painless with no visual disturbances

No discharge

Hemorrhage is sharply demarcated, unilateral and mostly on the inferotemporal side

As the hemorrhage resolves, it can change colour to blue or yellow.

Question 8

Give 5 differentials of SCH.

Answer 8

Traumatic
Globe rupture
Retrobulbar hematoma
Conjunctival laceration

Non traumatic
Conjunctivitis
Inflamed pterygium or pinguecula
Endophthalmitis
Acute angle closure glaucoma

Question 9

How is SCH diagnosed?

Answer 9

Clinical diagnosis

Slit lamp

Question 10

How is SCH managed?

Answer 10

Its usually self limiting, resorbed 2-3weeks and sometimes longer depending on the size therefore reassure the patient

Treat the underling cause when discovered

Ice pack if there is swelling and to stop the bleeding, as they constrict blood vessels

Lubricating eye drops to reduce irritation thus will stop rubbing their eyes or artificial tears