- Subconjunctival hemorrhage (SCH) is bleeding from small blood vessels underneath the conjunctiva, the thin clear skin covering the sclera (white part) of the eye.
- SCH is diagnosed clinically:
- Well-demarcated areas of extravasated blood can be seen just under the surface of the conjunctiva of the eye.
- Lesions can be flat, elevated, or bullous.
- Typically, SCH self-resolves in 1 to 3 weeks depending on the severity.
- Male = female; no gender predilection
- Common; 3% rate of diagnosis in ophthalmology clinics (1)
Etiology and Pathophysiology
- SCH results from damage to conjunctival and episcleral vessels from direct or indirect injury.
- Anti-thrombogenic and anti-coagulated states (blood dyscrasias, thrombocytopenia, anemia, anti-platelet use, anti-coagulant use) increase the risk and severity of SCH.
- Causes include the following:
- Idiopathic (most common cause)
- Direct trauma from
- Blunt or penetrating injury to the eye
- Contact lenses placement or removal; improper contact lenses wear
- Rubbing eyes
- Foreign body in eye
- Ocular surgery, injection, or other procedure
- Valsalva maneuvers causing sudden severe venous congestion such as coughing, sneezing, vomiting, straining, severe asthma or COPD exacerbation, weightlifting, or childbirth/labor
- Damaged vessels from atherosclerotic disease or diabetes (which is a cause of recurrent SCH without trauma)
- 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 (2).
- Contact lenses wearer
- Systemic diseases (HTN, diabetes)
- Bleeding disorders (1)
- Recent ocular surgery (cataract, laser-assisted in situ keratomileusis [LASIK])
- Avoid rubbing eyes.
- Proper cleaning and maintenance of contact lenses
- Protective eyewear in sports and hobbies
- Optimizing control of systemic diseases such as HTN, diabetes, atherosclerotic disease, and thrombocytopenia
- Control of PT/INR in patients on warfarin therapy (3)
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