Subconjunctival Hemorrhage

A massive amount of blood in the inferior medial quadrantof the conjunctiva and ecchymosis of the lowereyelid of the right eye prompted a 60-year-old woman toseek medical attention. She had first noted blood in theeye 5 days earlier. There was no history of trauma.Increased venous conjunctival pressure that resultsfrom coughing or sneezing can lead to vessel ruptureand subconjunctival hemorrhage. Much less commoncauses are blood dyscrasias, hypertension, coagulationdisorders (including elevated warfarin levels),and trauma. Cough from a postnasal drip and hypertensionwere thought to be contributing factors in this patient.There is no racial, ethnic, or genetic predispositionto subconjunctival hemorrhage, although patientswith inherited coagulopathies may be more susceptibleto the condition.No specific treatment is necessary; however, associatedsystemic disorders, such as hypertension andcoagulopathies, need to be controlled. Most important,reassure the patient that a subconjunctival hemorrhageresolves spontaneously over 4 to 6 weeks and changescolor as it heals, similar to a bruise.

(Case and photograph courtesy of Robert P. Blereau, MD.)