ECCHYMOSIS OF CONJUNCTIVA
Ecchymosis or subconjunctival haemorrhage is of very common occurrence.
It may vary in extent from small petechial haemorrhage to an extensive one spreading under the whole of the bulbar conjunctiva and thus making the white sclera of the eye invisible.
The condition though draws the attention of the patients immediately as an emergency but is most of the time trivial.
Etiology.
Subconjunctival haemorrhage may be associated with following conditions:
1. Trauma.
It is the most common cause of subconjunctival haemorrhage. It may be in the form of
(i) local trauma to the conjunctiva including that due to surgery and subconjunctival injections,
(ii) retrobulbar haemorrhage which almost immediately spreads below the bulbar conjunctiva.
Mostly, it results from a retrobulbar injection and from trauma involving various walls of the orbit.
2. Inflammations of the conjunctiva. Petechial subconjunctival haemorrhages are usually associated with acute haemorrhagic conjunctivitis caused by picornaviruses, pneumococcal conjunctivitis and leptospirosis, ictero haemorrhagica conjunctivitis.
3. Sudden venous congestion of head.
The subconjunctival haemorrhages may occur owing to rupture of conjunctival capillaries due to sudden rise in pressure.
Common conditions are whooping cough, epileptic fits, strangulation or compression of jugular veins and violent compression of thorax and abdomen as seen in crush injuries.
4. Spontaneous rupture of fragile capillaries may occur in vascular diseases such as arteriosclerosis, hypertension and diabetes mellitus.
5. Local vascular anomalies like telengiectasia, varicosities, aneurysm or angiomatous tumour.
6. Blood dyscrasias like anaemias, leukaemias and dysproteinaemias.
7. Bleeding disorders like purpura, haemophilia and scurvy.
8. Acute febrile systemic infections such as malaria, typhoid, diphtheria, meningococcal septicaemia, measles and scarlet fever.
9. Vicarious bleeding associated with menstruation is an extremely rare cause of subconjunctival haemorrhage.
Clinical features.
Subconjunctival haemorrhage perse is symptomless. However, there may be symptoms of associated causative disease.
On examination subconjunctival haemorrhage looks as a flat sheet of homogeneous bright red colour with well defined limits.
In traumatic subconjunctival haemorrhage, posterior limited is visible when it is due to local trauma to eyeball, and not visible when it is due to head injury or injury to the orbit. Most of the time it is absorbed completely within 7 to 21 days.
During absorption colour changes are noted from bright red to orange and then yellow. In severe cases, some pigmentation may be left behind after absorption.
Treatment.
(i) Treat the cause when discovered.
(ii) Placebo therapy with astringent eye drops.
(iii) Psychotherapy and assurance to the patient is most important part of treatment.
(iv) Cold compresses to check the bleeding in the initial stage and hot compresses may help in absorption of blood in late stages.
OPTOMETRY-SHARP VISION
Optometrist