EpistemisHyposphagma
Specialty: Ophthalmology.
Why it occurs
- Sudden increase in intrathoracic venous pressure due to Valsalva maneuver (persistent cough, repeated vomiting, severe constipation, strenuous physical exertion)
- Mild direct ocular trauma or vigorous rubbing of the eyeball
- Poorly controlled systemic arterial hypertension crisis
- Systemic blood dyscrasias, hemorrhagic diathesis or overdose of anticoagulant drugs (warfarin, acenocoumarol, new oral anticoagulants) or antiplatelet drugs (aspirin, clopidogrel)
- Viral conjunctivitis of acute hemorrhagic type (caused by enterovirus 70 or adenovirus)
Initial workup
Immediate measurement of systemic blood pressure at the time of discovery; General blood work including complete blood count, Prothrombin Time (PT), Activated Partial Thromboplastin Time (aPTT), platelet count and INR (in anticoagulated patients); Biomicroscopic evaluation with a slit lamp to rule out penetrating conjunctival wounds or associated hyphema in case of a direct history of trauma.
red flags
Spontaneous recurring hypophagma (more than 2 episodes in a year) without traumatic trigger or documented physical effort, or associated with the presence of spontaneous hematomas in extremities, epistaxis that is difficult to control or abundant gum bleeding, suggesting a serious alteration in the coagulation cascade or underlying leukemia.
Standard management
- No pharmacological treatment is required to resolve subconjunctival hemorrhage, which is spontaneously reabsorbed without leaving sequelae in a period of 7 to 21 days depending on its extent.
- Artificial tears with 0.5% Carboxymethylcellulose (apply 1 drop every 6 hours to relieve the slight sensation of a foreign body or friction produced by the raised conjunctival relief due to the accumulation of blood).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Ophthalmology
- Listed causes
- 5
- Treatment options
- 2