Ophthalmology
A 76 year old man presents to the Emergency Department with a red eye. He describes waking up, looking in the mirror and noticing his eye was bright red. He is otherwise well and denies any pain. He has no significant past medical history. On examination you note normal visual acuity in both eyes and normal pupillary reactions. You are able to see a visible posterior border to the redness. What is the most likely diagnosis?
Answer:
Subconjunctival haemorrhage is usually asymptomatic, there may occasionally be mild discomfort or a popping sensation at onset. On examination, there is an area of localised, well-demarcated haemorrhage in one eye, with a visible posterior border, in the absence of pain, no reduction of visual acuity, normal pupil reactions, and no corneal staining.Subconjunctival Haemorrhage
Ophthalmology
Last Updated: 12th February 2021
Subconjunctival haemorrhage results from bleeding of the conjunctival or the episcleral blood vessels into the subconjunctival space.
Risk factors
Subconjunctival haemorrhage usually occurs spontaneously. There may or may not be a history of a contributory factor, such as straining with coughing, vomiting or constipation. It may be associated with systemic hypertension, bleeding abnormalities or anticoagulant medication.
Clinical features
Subconjunctival haemorrhage is usually asymptomatic, there may occasionally be mild discomfort or a popping sensation at onset. On examination, there is an area of localised, well-demarcated haemorrhage in one eye, with a visible posterior border, in the absence of pain, no reduction of visual acuity, normal pupil reactions, and no corneal staining. Blood pressure should be measured in all patients.
Management
Reassure the patient that the condition usually clears within 5 - 10 days and a cold compress may reduce any discomfort. Advise the patient to return/seek further help if problem does not resolve or if it recurs.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
