Subconjunctival Hemorrage

A subconjunctival hemorrhage is bleeding below the transparent layer of the eye called the conjunctiva.


Causes

What causes it? Violent sneezing, coughing, vomiting, heavy lifting and minor blunt trauma. People at risk for this condition are those with diabetes, high blood pressure, and those who take blood thinners such as aspirin and coumadin (warfarin). Subconjunctival hemorrhages may sometimes present without a known cause.


Symptoms
The most discomforting aspect of a subconjunctival hemorrhage is its appearance. You may not realize that you have a subconjunctival hemorrhage until you see yourself in the mirror. The blood is tends to be bright red, and is flat, meaning it does not bulge against your eyelids. It is often painless, but one may experience a slight itching sensation. Your vision is not affected.


Evaluation
While subconjunctival hemorrhages are benign, it is important to distinguish it from more serious conditions such as a bloody chemosis which is more likely to bulge, and is associated with rupture of the sclera (white part of the eye), and cavernous sinus thrombosis (blood clot in a blood vessel of the brain). Also, in the setting of trauma, if a subconjunctival hemorrhage is located at the far lateral (toward the ear versus the nose) portion of the eye, it can mean a person has a fracture of the zygomatic arch (cheekbone).


Treatment
No treatment is required. The body will absorb the blood over 10-14 days. Recurring episodes require evaluation for bleeding disorders or uncontrolled high blood pressure.


For this and more information, check out the Mayo Clinic, American Optometric Association websites, and Knoop, Stack, and Storrow's Atlas of Emergency Medicine, 2nd Edition.

Health and Trends in Pop Culture: A look into Lady Gaga's Eyes

Lady Gaga's doe-eyed look in her "Bad Romance" video has caused a dangerous trend to catch on among teens in the U.S. Teens are purchasing "Circle Lenses," colored contact lenses that make the colored part of the eye (iris) appear larger. These lenses are illegal in the U.S. but are readily available on the Internet, so teens and young adults are buying them without seeing an eye doctor, having their eyes fitted for the lenses to ensure a proper fit, and without instruction in proper use. Poor use can cause scratches, called corneal abrasions, tears (lacerations), and infections of the eye, even blindness in rare cases.

To have even a corneal abrasion is a painful and inconvenient experience. I had it as a med student while on a trauma surgery rotation and they let me out for the day! The eye becomes extremely sensitive to light. and your vision is blurred. It causes one to feel unable to open the eye, because of the sensation that a tiny but sharp object is on the eye. The eye often waters constantly, and the more you rub and blink your eye, the worse pain becomes. The pain can be excruciating. It requires a doctor's visit for an exam and anesthetic, anti-inflammatory, and antibiotic eye drops or ointment and then follow up with a specialist. In terms of infections, even contact lenses prescribed by a doctor put people at risk for infections when not handled properly. Imagine the damage you could do using contact lenses that do not fit you and without proper instruction. The American Academy of Ophthalmology has discouraged the use of nonprescription cosmetic contact lenses which have been illegal in the U.S. since 2005.

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