II. Pathophysiology
- Bleeding from small Conjunctival vessels
III. Causes: Adults
- Minor Eye Trauma
- Spontaneously with increased venous pressure
- Blood dyscrasia (uncommon)
- Severe Hypertension
IV. Causes: Children
- Traumatic in 83% of cases under age 18 years
- Traumatic or inflammatory in >94% of cases in age <2 years
-
Nonaccidental Trauma (abusive Head Trauma)
- In non-mobile infants (esp. age <6 months), Subconjunctival Hemorrhage is highly suspicious
- Associated with concurrent Bruising (27%), Fractures (>15%) and Intracranial Hemorrhage (>5%)
- Koti (2021) J Pediatr Ophthalmol Strabismus 58(4):213-7 +PMID: 34288770 [PubMed]
VI. Precautions
- Exclude Globe Rupture when Subconjunctival Hemorrhage is Traumatic
- Consider with high velocity projectiles (e.g. grinding)
- Carefully evaluate diffuse Subconjunctival Hemorrhage (circumferential involving full 360 degrees)
- Associated with more serious Eye Trauma (e.g. periorbital Fracture, Retrobulbar Hematoma, Bleeding Disorder)
VII. Labs
VIII. Management
- Careful exam including Vision
- Eye Trauma resulting in bleeding requires an intensive evaluation
- Confirm no signs of Globe Rupture
- Reassurance
- Cold compresses
- Artificial tears
- Referral for question of greater injury (especially if Traumatic Eye Injury)
IX. Course
- Hemorrhage clears spontaneously in 1-2 weeks
X. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21