Download FB sub-tarsal - Vision 2020 UK

Version 6 (20.05.08)
Name: Wormald
CONDITION
Aetiology
Predisposing
factors
SUB-CONJUNCTIVAL HAEMORRHAGE
Usually idiopathic
Valsalva manoeuvre (eg coughing, straining, vomiting)
producing rise in central venous pressure
Traumatic (may be isolated or associated with ruptured globe or
retrobulbar haemorrhage)
Hypertension
Bleeding abnormality (leukaemia, clotting disorders)
Anticoagulant medication (aspirin, Warfarin)
Symptoms
Mild ache or irritation (no pain)
May be asymptomatic
Signs
Red area on eye caused by blood beneath the conjunctiva of
which the posterior border can be seen
Usually unilateral
No discharge
Differential
diagnosis
Haemorrhagic conjunctivitis (EHC)
- viral conjunctivitis (usually small multiple haemorrhages;
rare)
- usually bilateral
Conjunctival neoplasms (eg lymphoma) with secondary
haemorrhage
Kaposi’s sarcoma (red or purple lesions under conjunctiva)
Management by Optometrist
Non-pharmacological History is important. Ask about hypertension, medications, acute
or chronic cough, eye rubbing, heavy lifting, trauma, bleeding or
clotting abnormalities and recurrent subconjunctival
haemorrhage
Exclude a conjunctival vascular lesion
Measure intraocular pressure
COMMENTS
Also recent eye surgery! (RW)
Epidemic! Highly contagious – Apollo eye (RW)
Version 6 (20.05.08)
Name: Wormald
CONDITION
Pharmacological
SUB-CONJUNCTIVAL HAEMORRHAGE
Measure blood pressure
In traumatic cases exclude
- ruptured globe (abnormally deep anterior chamber, low
IOP, hyphaema, subconjunctival oedema, vitreous
haemorrhage, reduced motility, retinal haemorrhage,
reduction of visual acuity)
- retrobulbar haemorrhage (proptosis, raised IOP,
conjunctival swelling, reduction in visual acuity)
Ensure that posterior border of haemorrhage can be seen, to
exclude intra-cranial source
If patient has history of recurrent subconjunctival haemorrhages
or a history of bleeding or clotting abnormalities, refer to GP
Reassure patient
Condition usually clears within 5-10 days
Cold compress may reduce discomfort
Advise patient to return/seek further help if problem does not
resolve or if it recurs.
Tear supplement / ocular lubricant if mild ocular irritation is
present
COMMENTS
B3: management to resolution
Refer to GP if suspicion of hypertension or bleeding disorder
Possible management by Ophthalmologist
Possible management by Ophthalmologist
(Not normally referred)
Investigate for underlying cause of subconjunctival haemorrhage
Cauterise bleeding vessel if found
Evidence base
Version 6 (20.05.08)
Name: Wormald
CONDITION
SUB-CONJUNCTIVAL HAEMORRHAGE
Clinical consensus
(Oxford Centre for Evidence-based Medicine Level of Evidence
= 5)
COMMENTS
No comment! (RW)