Spontaneous Subconjunctival Hemorrhage Research Articles

Overt and Massive Spontaneous Subconjunctival Hemorrhage on a Patient with Prolonged International Normalized Ratio on Therapeutic Warfarin: A Case Report.

Overt and Massive Spontaneous Subconjunctival Hemorrhage on a Patient with Prolonged International Normalized Ratio on Therapeutic Warfarin: A Case Report.

The Clinical Case of Idiopatic Dilatation of Epibulbal Veins

This publication describes a clinical case of spontaneous subconjunctival hemorrhage in a 15-year-old child on the background of idiopathic local dilatation of epibulbar vessels. Vascular pathology of the orbit and periorbital region is often accompanied by subconjunctival hemorrhages. The aim of the work was to describe a rare clinical case of spontaneous subconjunctival hemorrhage in a child with local idiopathic vasodilation. A complete clinical instrumental study revealed no pathology except the local dilatation of epibulbar vessels. In 6 months after the subconjunctival hemorrhage resorption, the ampoule-shaped expansion of the epibulbar vessels with a wall different from others in color and shape is preserved, which was confirmed by the data of optical coherence tomography (OCT) of the anterior eye segment. When examining patients with spontaneous subconjunctival hemorrhage, especially in childhood, along with pathology of the cardiovascular and circulatory systems, it is necessary to exclude malformations of the vessels of the orbit, periorbital region and anomalies of the epibulbar vessels.

Reasons for visits to an emergency center and hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage.

To evaluate causes of visits to the Eye Emergency Department, determine the prevalence of subconjunctival hemorrhage (SCH), and assess the role of hemostatic abnormalities among patients with spontaneous recurrent SCH (SRSCH). In a prospective study conducted over 2 years, hemostatic function was studied in a subgroup of 105 consecutive patients (39 male) with SRSCH free of systemic risk factors and in 53 age- and sex-matched healthy controls (HC) (24 male). A total of 10,090 patients (mean age 57.2 ± 16.7 years, range 0-94, median 58.4) were evaluated. A total of 39.3% had ocular trauma, 34.9% inflammatory ocular surface disorder, 5.7% floaters, 3.3% visual symptoms of neurologic origin, 1.6% uveitis, 1.5% ocular hypertension, 0.8% retinal tear or detachment, 0.7% retinal vascular disease, and 0.5% other causes. A total of 1.6% of the patients were hospitalized. A total of 11.7% of patients had SCH: in 86.7% it was spontaneous, in 13.3% consequent to trauma or to ocular surface disorders. A total of 105 patients had SRSCH, and the prevalence of hemostatic abnormalities among them was not different from HC. Type I von Willebrand disease was diagnosed in 1 patient with SCH and in none of the HC (χ² = 0.13, p = 0.72). Most patients had ocular infection or trauma and were treated on an outpatient basis; SCH was the third cause of access. The large majority of SCH were unprovoked, and the prevalence of hemostatic alterations in patients with SRSCH and no systemic causes was not different from the general population. Hemostatic screening or second level blood clotting tests were of no use in these patients.

Prevalence of hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage.

Subconjunctival hemorrage (SCH) is a frequent, mild bleeding manifestation and a common cause of consultation. Hemostatic alterations are possible causes of SCH but their role and prevalence is unknown. We assessed the prevalence of hemostatic abnormalities in patients with spontaneous, recurrent SCH to clarify the role of the hemostasis laboratory in this clinical setting. A total of 105 SCH patients (21-78 years, 65 females) with no identifiable cause (hypertension-trauma-conjunctivitis) or concomitant treatments (NSAIDs- aspirin-oral anticoagulants-antiplatelet agents) and 53 age and sex-matched healthy controls (HCs) (22-72 years, 29 females) were evaluated for skin bleeding time, PFA-100®, blood clotting screening, platelet count, light transmission aggregomery, VWF:Ag, VWF:RCo, RIPA, FVIII activity, FXIII antigen and activity and ISTH Bleeding Severity Score (BSS). Prevalence of hemostatic abnormalities was not higher in the SCH population than in HCs BSS was 0.83 (95% CI 0.62-1.06) in SCH and 0.66 (0.37-0.95) in HC (p=NS). Type I Von Willebrand disease was diagnosed in one SCH and none HC patients, a prevalence not significantly different (p=NS by χ2). The prevalence of hemostatic alterations in patients with recurrent, spontaneous SCH is not different from the general population; hemostatic screening or second level tests are of no use in patients with recurrent SCH and no other bleedings.

The application of continuous positive airway pressure in association with obstructive sleep apnea syndrome and subconjunctival hemorrhage due to hypertensive attacks: case reports

Introduction Spontaneous subconjunctival hemorrhage associated with hypertension (HT) is common. Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for HT. Blood pressure during obstructive sleep apnea can increase up to 20% and reaches its highest level with the end of apnea. Materials and methods Case: 60-year-old male patient, BMI: 30.9 kg/m 2 , had complaints of subconjunctival hemorrhage in the morning after sleeping, repeated three times in the last two years. He described occasional complaints of snoring and daytime sleepiness. There was no history of trauma, antiplatelet therapy, and bleeding disorders. He was being taken regular medication for 5 years with a diagnosis of hypertension. In the color fundus imaging, hypertensive retinopathy was detected. Twice Holter monitoring was performed in patient with hypertension (Table 1). Day–night rates of the critical levels of systolic BP, day: 0%, 7%, and night: increased to 15%, 13%, diastolic BP, day: 0%, 0%, and night: increased to 0% to 13% were found. Oxygen saturation was monitored during sleep at night, and desaturation was observed. Then polysomnography test was performed. In polysomnography, apnea hypopnea index (AHI) was 45.8, and the patient was diagnosed with OSAS. Results Consequently, continuous positive airway pressure (CPAP) therapy was given. After the current antihypertensive treatment and CPAP treatment, systole: 2% at night, 1% critical level during the day was found significantly lower in the Holter monitoring. There was no recurrence of bleeding after CPAP treatment. Conclusion In our case, recurrence of subconjunctival hemorrhage due to hypertensive episodes caused by OSAS was observed. After CPAP treatment, subconjunctival hemorrhage due to hypertensive attacks did not relapse, because of regular course of blood pressure. The patients with complications of hypertension should be considered in terms of OSAS, because CPAP treatment prevents hypertensive episodes by night. Acknowledgements OSAS, subconjunctival hemorrhage due to hypertensive attacks.

Analysis of subconjunctival hemorrhage

Objective: To determine associated conditions, gender distribution and location of subconjunctival hemorrhage (SCH). Methodology: This retrospective, observational and non-interventional study involved total of 50 patients with SCH aged 0.16-88 years. The conjunctiva was divided into 4 equal areas. The data about the subjects with SCH that includes age, gender, medical history, ocular history and location of hemorrhage were noted for all patients. Results: The patients with SCH consisted of 21 (42%) women and 29 (58%) men, with a mean age of 29.56 years. Of the 50 patients, 34 (68%) had traumatic and 16 (32%) had spontaneous SCH. Of traumatic SCH group 24 (70.6%) were men and 10 (29.4%) were women. SCH was more common in the temporal areas than other areas (40.5%). Conclusion: The most associated condition in spontaneous SCH was hypertension. SCH was found to be predominant in the temporal areas among all patients. In traumatic SCH, temporal areas were affected more, whereas in spontaneous SCH, nasal and temporal areas were affected equally. Traumatic etiology was more likely seen in men than women.

Hémorragie sous-conjonctivale bilatérale massive révélatrice d’une leucémie aiguë lymphoblastique

We report the case of 20-year-old patient who presented in emergency with bilateral massive, spontaneous subconjunctival hemorrhage. Clinical findings suggested a blood dyscrasia, which was confirmed by blood cell count. The patient was urgently referred to hematology where the diagnosis of acute lymphoblastic leukemia was made. This case highlights the importance of working up any unusual subconjunctival hemorrhage, as it may reveal, in certain cases, a severe life-threatening disease.

Prevalence of factor XIII Val34Leu polymorphism in patients affected by spontaneous subconjunctival hemorrhage

Purpose To verify the prevalence of Val34Leu polymorphism in factor XIII A-chain gene (FXIII Val34Leu) in patients with spontaneous subconjunctival hemorrhage (SCH). Design Nonrandomized case-control study. Methods One hundred seven white patients suffering from one or more episodes of idiopathic SCH and 107 healthy subjects were matched for age and gender, and genotyped for FXIII Val34Leu. Anamnestic, ophthalmologic, cardiovascular, and serologic examinations were performed. Results Frequency of FXIII mutated allele (Leu34) was significantly higher in SCH patients than in controls. Computing together heterozygotes (Val/Leu) and homozygotes (Leu/Leu), genotype distribution was statistically different. In a conditional logistic regression model, the comparison of the three separated genotypes, performed among 25 patients with recurrent idiopathic SCHs and controls, gave significant differences for both Val/Leu and Leu/Leu variables. Conclusion Both homozygosity and heterozygosity for FXIII Val34Leu predispose to idiopathic SCH, emphasizing the role of Leu34 allele as inherited risk factor for spontaneous, especially recurrent, SCHs.

Subconjunctival Hemorrhage: The First Presenting Clinical Feature of Idiopathic Thrombocytopenic Purpura

Background: Subconjunctival hemorrhage as the first presenting clinical feature of idiopathic thrombocytopenic purpura, to the best of our knowledge, has not been reported earlier. Case: A 60-year-old woman presented with an isolated finding of subconjunctival hemorrhage. She later developed hemorrhage from retinal vessels and had a single episode of hematuria. Observations: Her blood cell count showed an extremely low platelet count. Her medical history and clinical examination for any other systemic or ophthalmic pathology were negative. Even after treating the patient with blood and platelet transfusion and maintaining her on high doses of systemic steroids, she did not respond well. Conclusion: The appearance of spontaneous subconjunctival hemorrhage in a patient should be thoroughly investigated as it can be an initial sign of a grave systemic disorder.

Recurrent episodes of spontaneous subconjunctival hemorrhage in patients with factor XIII Val34Leu mutation

Purpose To report on the occurrence of frequent episodes of spontaneous subconjunctival hemorrhage (SCH) in patients with the Leu 34 allele of the coagulation factor XIII (FXIII), known to be associated with high hemorrhagic risk. Design Observational case series. Methods Five young adults who had suffered from recurrent idiopathic SCH not associated with any recognized ocular and systemic hemorrhagic risk factor were investigated. Accurate anamnestic, ophthalmologic, hematologic, and serologic examinations were performed, together with blood pressure measurements, electrocardiogram (ECG), and 24-hour Holter ECG recordings. FXIII Val34Leu polymorphism was studied by DNA chain polymerase reaction. Results DNA analyses showed that the hemorrhagic mutated Leu34 allele was present in four of our selected patients: two mutated homozygotes (Leu/Leu) and two heterozygotes (Val/Leu). In the last subject this polymorphism was not detected. All the other clinical evaluations did not disclose any significant abnormality. Conclusions The FXIII Val34Leu mutation may be associated with an increased risk for spontaneous episodes of SCH.