UMEM Educational Pearls

Title: What's the Diagnosis? Image submitted by Dr. Zachary Dezman

Posted: 6/24/2012 by Haney Mallemat, MD (Emailed: 6/25/2012) (Updated: 6/25/2012)
Click here to contact Haney Mallemat, MD

Question

77 year old male presents to the Emergency Department one week after a motor vehicle crash in which he suffered minor facial injuries. He is now concerned because his eye looks like this. Diagnosis?

Answer

Answer: Subconjunctival Hemorrhage

Subconjunctival hemorrhage is the accumulation of blood between the conjunctiva and sclera (i.e., subconjunctival space) secondary to bleeding from conjunctival or episcleral blood vessels.

Subconjunctival hemorrhage may be caused by:

Trauma
Excessive coughing or valsalva
High-blood pressure
Coagulopathy: acquired (e.g., aspirin use) or inherited (e.g., Factor VIII deficiency)
Post-occular surgery (normal complication)
Febrile systemic-infections (e.g., meningococcal septicemia)
Following CPR-associated chest compressions
Post-cardiac angiography or open-heart surgery

Treatment should be directed towards reversing the underlying cause and providing symptomatic relief (e.g., artificial tears)

Prognosis is typically good. Occasionally the hemorrhage becomes yellowish-green (similar to a bruise) during the healing phase; this eventually resolves.

Bonus Pearl: As July 1rst approaches a new class of doctors will begin their journey to become Emergency Medicine specialists. The EM Basic website, created by Dr. Steve Carroll, was developed as a boot camp guide for Emergency Medicine. At the EM Basic website, you can find podcasts and discussions of must know topics within Emergency Medicine. Check it out today at http://embasic.org or on iTunes

References

Follow me on Twitter (@criticalcarenow) or Google+ (+haney mallemat)