CHAPTER I INTRODUCTION

A red eye is a cardinal sign of ocular inflammation, which can be caused by several conditions (eg, subconjunctival hemorrhage (see the image below), defined as blood between the conjunctiva and the sclera
[1, 2]

). Most cases are benign and can be

[3]

effectively managed by the primary care provider. The key to management is recognizing cases with underlying disease that require ophthalmologic consultation.

Subconjunctival Hemorrhage
A subconjunctival hemorrhage is characterized by red, flat discoloration due to bleeding from the small blood vessels that run through the conjunctiva. The most common cause for spontaneous subconjunctival hemorrhage is idiopathic in nature; the condition is painless, clearing itself within 7 to 14 days. In a few cases, the redness may be associated with bleeding disorders, the use of anticoagulants, conjunctivitis, scleritis, or trauma to the eye. Warm compresses may be useful in symptomatic relief. Treatment involves the identification and appropriate management of the underlying cause.[1,5,7]
Subconjunctival Hemorrhage Overview
The conjunctiva is the thin, moist, transparent membrane that covers the white part of the eye (called the sclera) and the inside of the eyelids. The conjunctiva is the outermost protective coating of the eyeball. The conjunctiva contains nerves and many small blood vessels. These blood vessels are usually barely visible but become larger and more visible if the eye is inflamed. These blood vessels are somewhat fragile, and their walls may break easily, resulting in a subconjunctival hemorrhage (bleeding under the conjunctiva). A subconjunctival hemorrhage appears as a bright red or dark red patch on the sclera.

Subconjunctival Hemorrhage Causes

Most subconjunctival hemorrhages are spontaneous without an obvious cause for this bleeding from the conjunctival vessels. Often, a person may discover a subconjunctival hemorrhage on awakening and looking in the mirror. Most spontaneous subconjunctival hemorrhages are first noticed by another person seeing a red spot on your eye. The following can occasionally result in a spontaneous subconjunctival hemorrhage: sneezing,

coughing,

straining/vomiting,

eye rubbing,

trauma (injury),

high blood pressure,

bleeding disorder, or

a medical disorder causing bleeding or inhibiting normal clotting. Subconjunctival hemorrhage can also be non-spontaneous and result from a severe eye infection, trauma to the head or eye, or after eye or eyelid surgery.

Subconjunctival Hemorrhage Symptoms

Most of the time, no symptoms are associated with a subconjunctival hemorrhage other than seeing blood over the white part of the eye. Very rarely do people experience any pain when the hemorrhage begins. When thebleeding first occurs, you may experience a sense of fullness in the eye or under the lid. As the hemorrhage resolves, some people may experience very mild irritation of the eye or merely a sense of awareness of the eye.

The hemorrhage itself is an obvious, sharply outlined bright red area overlying the sclera. The entire white part of the eye may occasionally be covered by blood.

In a spontaneous subconjunctival hemorrhage, no blood will exit from the eye. If you blot the eye with a tissue, there should be no blood on the tissue.

The hemorrhage will appear larger within the first 24 hours after its onset and then will slowly decrease in size as the blood is absorbed.

When to Seek Medical Care

Call your ophthalmologist (a medical doctor who specializes in eye care and surgery) if the subconjunctival hemorrhage does not get better within two weeks or if you have had multiple subconjunctival hemorrhages. Also, call your ophthalmologist if you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with other symptoms of bleeding including easy bruising, bleeding gums, or both. Go to your ophthalmologist immediately if you have a subconjunctival hemorrhage and you have pain associated with the hemorrhage,

changes in vision (for example, blurry vision, double vision, difficulty seeing),

history of a bleeding disorder,

history of high blood pressure, or

injury from trauma to the eye.

Exams and Tests

Your ophthalmologist takes a concise history of the events prior to the subconjunctival hemorrhage and performs an examination. Your blood pressure may also be checked. If trauma was the cause, a more thorough examination using a slit lamp (a special microscope for examining the eye) will usually be performed.

Subconjunctival Hemorrhage Treatment Self-Care at Home

Usually, no treatment is needed. Over-the-counter artificial tears can be applied to the eye if mild irritation is present. The use of aspirin or ibuprofen should be avoided Medical treatment Usually, no treatment is required. Your ophthalmologist may prescribe artificial tears to ease any irritation that may be present. If the injury is related to trauma, your ophthalmologist may need to examine your eye to rule out the possibility of damage to other parts of the eye.

Next Steps Outlook

This condition clears by itself within one to two weeks. Usually, recovery is complete, without any long-term problems, similar to a mild bruise under the skin. Like a bruise, a subconjunctival hemorrhage changes colors (often red to orange to yellow) as it heals. A skin bruise changes to various shades of green, black and blue as it heals, because the blood is being seen though skin. Because the conjunctiva is transparent, a subconjunctival hemorrhage never has these color characteristics.