Pictorial case study - Red eye with unaffected vision

Assessing subconjunctival haemorrhage. By Dr Jean Watkins

Presentation

This 26-year-old man was surprised when he awoke one morning, looked in the mirror and noticed the bright red discoloration in his right eye. Although he felt otherwise well, and had no other symptoms and no pain in his eye, he sought advice from his GP.

He gave no history of recent injury and was not taking anticoagulants. Careful examination of the eye found his vision to be unaffected and there were no other abnormalities present. The posterior margin of the haemorrhage was clearly defined, so the possibility of an intracranial bleed was ruled out and his BP was normal.

Management

The patient was reassured this was a subconjunctival haemorrhage, which should resolve spontaneously, fading through green to yellow without treatment in seven to 10 days. Any discomfort in the eye might be eased by the use of artificial tears or ocular lubricant.

Discussion

The cause of subconjunctival haemorrhage is unknown and although it is more common in the elderly, it can occur at any age.

Sometimes it may be associated with coughing or straining, accidental or surgical trauma, hypertension or patients with bleeding disorders or on anticoagulants. Investigations are usually unnecessary, apart from checking BP. In cases of recurrent subconjunctival haemorrhage or where there is a history of nosebleeds or excessive bruising, FBC, including platelets, prothrombin time, activated partial thromboplastin time, and protein C and S are required to exclude an underlying bleeding disorder.

Differential diagnoses

  • Conjunctivitis
  • Episcleritis
  • Uveitis (iritis)
  • Injury, foreign body
  • Corneal ulceration
  • Dr Watkins is a retired GP in Hampshire Glaucoma

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