Pandemic Influenza A (H1N1) Infection and Subconjunctival Hemorrhage: Report of Three Cases

Abstract

Subconjunctival hemorrhage (SCH) is defined as blood between the conjunctiva and the sclera. It can be caused by heavy lifting, coughing, and vomiting or by some infectious diseases. While conjunctivitis due to H1N1 influenza is reported, there is no SCH reported in the literature subsequent to H1N1 infection. We describe SCH in three patients with pandemic influenza H1N1 infection who were treated in intensive care unit (ICU). The first case is a 25-year-old pregnant woman with a 5-day history of runny nose mild cough and unilateral SCH. The second patient is a 37-year-old woman, with the diagnosis of pandemic H1N1 infection and diagnosed with bilateral SCH. Lastly, the third patient, a 49-year-old woman, was admitted to ICU with a 4-day history of cough, sputum and shortness of breath and diagnosed with bilateral SCH after 13 days of stay in ICU. None of these patients complained about visual changes, lacrimation or pain. Any increase in severity of SCH did not occur, and the findings resolved spontaneously within a few days in all patients. These cases suggest that intensivists and ophthalmologists should be aware of ocular manifestation such as subconjunctival hemorrhage in patients with H1N1 infection.