[Emergency] Atlas of Subconjunctival Hemorrhage

These are pictures of Subconjunctival Hemorrhage. This is a part in OPHTHALMIC TRAUMA of the Atlas of Emergency Medicine book

Clinical Summary

A subconjunctival hemorrhage or hematoma occurs with often trivial events such as a cough, sneeze, Valsalva maneuver, or minor blunt trauma. The patient may present with some degree of duress secondary to the appearance of the bloody eye. The blood is usually bright red and appears flat. It is limited to the bulbar conjunctiva and stops abruptly at the limbus. This appearance is important to differentiate the lesion from bloody chemosis, which can occur with scleral rupture or nontraumatic conditions. Aside from appearance, this condition does not cause the patient any pain or diminution in visual acuity.

Management and Disposition

No treatment is required. Instruct the patient to expect the blood to resorb in 2 to 3 weeks.

Pearls

1. Subconjunctival hematoma differs from bloody chemosis with the flat appearance of the conjunctival membranes.

2. A subconjunctival hematoma involving the extreme lateral globe after blunt trauma is very suspicious for zygomatic arch fracture.

3. Evaluate patients with nontraumatic bloody chemosis for an underlying metabolic (coagulopathy) or structural (cavernous sinus thrombosis) disorder 

FIGURE 4.7 ■ Subconjunctival Hemorrhage. Subconjunctival hemorrhage 

from blunt trauma. The flat appearance of the hemorrhage suggests its benign nature. 

FIGURE 4.8 ■ Subconjunctival Hemorrhage. Subconjunctival
hemorrhage that completely surrounds the eye, but stops abruptly at
the limbus in a patient with blunt trauma. 

FIGURE 4.9 ■ Traumatic Bloody Chemosis. Suspicious for globe penetration, 

open globe was ruled out in this patient with CT. Dilated
pupil is a result of pharmacologic agent.