Subconjunctival Hemorrhage

A massive amount of blood in the inferior medial quadrant of the conjunctiva and ecchymosis of the lower eyelid of the right eye prompted a 60-year-old woman to seek medical attention. She had first noted blood in the eye 5 days earlier. There was no history of trauma. Increased venous conjunctival pressure that results from coughing or sneezing can lead to vessel rupture and subconjunctival hemorrhage. Much less common causes are blood dyscrasias, hypertension, coagulation disorders (including elevated warfarin levels), and trauma. Cough from a postnasal drip and hypertension were thought to be contributing factors in this patient. There is no racial, ethnic, or genetic predisposition to subconjunctival hemorrhage, although patients with inherited coagulopathies may be more susceptible to the condition. No specific treatment is necessary; however, associated systemic disorders, such as hypertension and coagulopathies, need to be controlled. Most important, reassure the patient that a subconjunctival hemorrhage resolves spontaneously over 4 to 6 weeks and changes color as it heals, similar to a bruise.

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