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- Subconjunctival hemorrhage (SCH) is bleeding from small blood vessels underneath the conjunctiva, the thin clear skin covering the sclera of the eye.
- SCH is diagnosed clinically:
- Flat, well-demarcated areas of extravasated blood can be seen just under the surface of the conjunctiva of the eye (red patch of blood sign).
- SCH is more common in the inferior and temporal regions of the eye (1).
- Typically, SCH resolves spontaneously within 2 weeks.
- Male = female; no gender predilection
- Common; 3% rate of diagnosis in ophthalmology clinics (2)
Etiology and Pathophysiology
- Direct trauma to the blood vessels of the conjunctiva from blunt or penetrating trauma to the eye
- Direct trauma to the conjunctiva from improper contact lens placement or improper cleaning
- Increased blood pressure (BP) in the vessels of the conjunctiva from HTN or from the temporary increase in BP from a Valsalva type maneuver (e.g., vomiting, sneezing)
- Damaged vessels from diabetes or atherosclerotic disease
- Increased bleeding tendencies from either thrombocytopenia or elevated prothrombin time (PT)/elevated international normalized ratio (INR) (4)
- Valsalva maneuvers causing sudden severe venous congestion such as coughing, sneezing, vomiting, straining, severe asthma or COPD exacerbation, weightlifting or childbirth/labor (1)
- In patients age >60 years, HTN is the most common etiology.
- In patients age <40 years, trauma/Valsalva and contact lenses use are the most common etiologies.
- In patients age >40 years, conjunctivochalasis (redundant conjunctival folds) and presence of pinguecula are strongly associated (3).
- Contact lenses wearer
- Systemic diseases (HTN, diabetes)
- Bleeding disorders (2)
- Recent ocular surgery (cataract, laser-assisted in situ keratomileusis [LASIK])
- Correct cleaning and maintenance of contact lenses
- Protective eyewear in sports and hobbies
- Optimizing control of systemic diseases such as HTN, diabetes, and atherosclerotic disease
- Control of PT/INR in patients on warfarin therapy (5)