Subconjunctival hemorrhage (SCH) is a benign eye condition that is often noticeable and leads to medical attention. Despite previous studies investigating the relationship between SCH and cardiovascular diseases, the relationship between SCH and bleeding disorders remains controversial. In order to gain further insight into this association, a nationwide cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort version 2.0 from 2006 to 2015. The study defined SCH using a diagnostic code and compared the incidence and risk factors of intracerebral hemorrhage (ICH) and gastrointestinal (GI) bleeding in 36,772 SCH individuals and 147,088 propensity score (PS)-matched controls without SCH. The results showed that SCH was associated with a lower risk of ICH (HR = 0.76, 95% CI = 0.622-0.894, p = 0.002) and GI bleeding (HR = 0.816, 95% CI = 0.690-0.965, p = 0.018) when compared to the PS-matched control group. This reduced risk was more pronounced in females and in the older age group (≥ 50 years), but not observed in males or younger age groups. In conclusion, SCH dose not increase the risk of ICH and major GI bleeding and is associated with a decreased incidence in females and individuals aged ≥ 50 years.
Conjunctival Diseases , Eye Hemorrhage , Hemorrhagic Disorders , Male , Female , Humans , Aged , Cohort Studies , Eye Hemorrhage/epidemiology , Eye Hemorrhage/etiology , Cerebral Hemorrhage , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Hemorrhage/etiology , Risk Factors , Conjunctival Diseases/epidemiology , Conjunctival Diseases/etiology
Conjunctival Diseases , Eye Hemorrhage , Eye Injuries , Lens Subluxation , Humans , Eye Injuries/complications , Eye Injuries/diagnosis , Eye Injuries/surgery , Lens Subluxation/diagnosis , Lens Subluxation/etiology , Lens Subluxation/surgery , Conjunctival Diseases/diagnosis , Conjunctival Diseases/etiology , Eye Hemorrhage/diagnosis , Eye Hemorrhage/etiology
Subconjunctival hemorrhages commonly present to eye care professionals and are frequently regarded as benign self-limited conditions. In selected cases, subconjunctival hemorrhages can be a harbinger of more severe disease. Perivascular epithelioid cell tumors, or PEComas, are rare mesenchymal neoplasms believed to originate from perivascular myoid cells and are rarely present in ocular structures. We present a rare case of a conjunctival perivascular epithelioid cell tumor that initially presented with recurrent subconjunctival hemorrhage. To our knowledge, this is the first description of a PEComa with a RBM10-TFE3 gene fusion, only previously seen with renal cell carcinoma. Physicians should be aware of this rare condition, its location in the fornix and its presentation as a recurrent subconjunctival hemorrhage.
Eye Hemorrhage , Perivascular Epithelioid Cell Neoplasms , Humans , Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics , In Situ Hybridization, Fluorescence , Perivascular Epithelioid Cell Neoplasms/genetics , Perivascular Epithelioid Cell Neoplasms/pathology , Eye Hemorrhage/diagnosis , Eye Hemorrhage/etiology , Hemorrhage , Biomarkers, Tumor , RNA-Binding Proteins/genetics
OBJECTIVE: Subconjunctival hemorrhage (SCH) is a common presentation in patients with orbital trauma and often warrants investigation of underlying ocular pathology. Our study aims to assess the significance of SCH severity, graded in a spatial 0-360° manner, as a predictor for ocular pathology in patients with orbital fracture. DESIGN: Retrospective chart review. PARTICIPANTS: Patients with fractured orbits (nâ¯=â¯265) presenting to a level 1 trauma centre between August 2015 and January 2018. METHODS: Key elements of ophthalmic assessment, including visual acuity, SCH (0-360°), anterior- and posterior-segment examination, Hertel exophthalmometry, and ocular pathology, were recorded. Simple logistic regression assessed for association between SCH severity and ocular pathology. Odds ratios (ORs) were calculated with 95% CI. RESULTS: Among the 265 fractured orbits, 158 (59.6%) presented with no SCH, and 107 (40.4%) had some degree of SCH. Ocular pathology was noted in 24 fractured orbits (9%). Most common pathologies included entrapment (22.2%), hyphema (16.7%), traumatic optic neuropathy (8.3%), and commotio retinae (8.3%). Simple logistic regression revealed a higher incidence of ocular pathology with increasing severity of SCH from 0-360° (ORâ¯=â¯1.004; 95% CI 1.001-1.007; pâ¯=â¯0.0085). In addition, χ2 analysis demonstrated a higher proportion of ocular pathology in 181-270° (25.0%; pâ¯=â¯0.0466) and 271-360° SCH subgroups (26.3%; pâ¯=â¯0.0031) compared with the 0° SCH subgroup (6.3%). CONCLUSIONS: Our findings suggest that there is some correlation between the extent of SCH and ocular pathology. However, patient care and investigations should continue to be directed by a full clinical assessment of patients with orbital trauma.
Conjunctival Diseases , Eye Hemorrhage , Eye Injuries , Orbital Fractures , Humans , Orbital Fractures/complications , Orbital Fractures/diagnosis , Retrospective Studies , Eye Hemorrhage/diagnosis , Eye Hemorrhage/etiology , Conjunctival Diseases/diagnosis , Conjunctival Diseases/etiology , Hyphema , Eye Injuries/complications , Eye Injuries/diagnosis , Eye Injuries/epidemiology
An adult patient in their 70s presented with unilateral painless proptosis and blurred vision of the right eye that resolved with corticosteroid treatment. Magnetic resonance imaging revealed a retrobulbar hemorrhage. Six months later, the hemorrhage and proptosis recurred, with incomplete resolution despite similar treatment. What would you do?
Exophthalmos , Eye Hemorrhage , Orbital Diseases , Retrobulbar Hemorrhage , Humans , Aged , Eye Hemorrhage/diagnosis , Eye Hemorrhage/etiology , Hemorrhage , Retrobulbar Hemorrhage/diagnostic imaging , Retrobulbar Hemorrhage/etiology , Orbital Diseases/diagnostic imaging , Orbital Diseases/etiology
Background: Expulsive suprachoroidal hemorrhage is a rare but dreadful complication of any ophthalmic surgery. Hence an ophthalmologist should know about the various risk factors, methods for preventing such a situation, and be aware of the various options for timely management to tackle the situation. Purpose: To discuss the risk factors, intraoperative signs, and ways of managing expulsive choroidal hemorrhage. Synopsis: We discuss two cases having multiple risk factors, where the patients underwent tectonic penetrating keratoplasty. In view of extensive involvement of ocular structures, the patients were clearly explained about the guarded visual prognosis and the risk of auto-evisceration. Following trephination of host cornea, rise in intraocular pressure was identified by the increasing size of the vitreous seen prolapsing through the wound and markedly visible pulsations, along with subconjunctival bleeding. Suprachoroidal hemorrhage was suspected and immediate tamponade was given. However, bleeding was not controlled, and eventually, expulsion of all the intraocular contents occurred. Highlights: A surgeon must be aware of the risk factors, be prompt to identify the signs, and must take immediate actions for the management of expulsive choroidal hemorrhage, a rare but dreadful complication of intraocular procedures. Online Video Link: https://youtu.be/UnCH-lWGzwU.
Choroid Hemorrhage , Eye Hemorrhage , Choroid Hemorrhage/diagnosis , Choroid Hemorrhage/etiology , Choroid Hemorrhage/surgery , Eye Hemorrhage/diagnosis , Eye Hemorrhage/etiology , Hemorrhage , Humans , Keratoplasty, Penetrating/adverse effects , Risk Factors
OBJECTIVE: Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury, but there are limited published data about SCH during childhood. We sought to determine the prevalence and causes of SCH in children. METHODS: This is a retrospective cross-sectional study of children seen by pediatric ophthalmologists in an outpatient setting over 4 years. Primary outcomes were prevalence and causes of SCH, based on history, physical ocular and nonocular findings, and laboratory and imaging studies. Subconjunctival hemorrhage prevalence was determined including and excluding eye surgery to reduce bias in the prevalence estimate. RESULTS: We studied 33,990 children, who underwent 86,277 examinations (median age, 5 years; range, 2 days to 18 years; 9282 younger than 2 years, 13,447 age 2-7 years, 11,261 age 8-18 years). There were 949 cases of SCH (1.1%; 95% confidence interval, 1.0-1.2). When surgery was excluded, there were 313 cases (prevalence, 0.4%; 95% confidence interval, 0.3-0.4), of which 261 (83%) were due to trauma; 40 (13%) ocular surface inflammation, including infectious conjunctivitis; 7 (2%) orbital or conjunctival lesion; 3 (1%) vessel rupture from choking or cough; and 2 (1%) coagulopathy related. Across all ages, including less than 2 years, trauma and inflammation together accounted for 94% to 97% of all cases of SCH. CONCLUSIONS: Subconjunctival hemorrhage is uncommon in children. The great majority of cases are due to trauma. All children with SCH, including infants and young children, should be closely examined to identify other ocular or nonocular signs of trauma.
Conjunctival Diseases , Eye Hemorrhage , Adolescent , Child , Child, Preschool , Conjunctival Diseases/complications , Conjunctival Diseases/etiology , Cross-Sectional Studies , Eye Hemorrhage/diagnosis , Eye Hemorrhage/epidemiology , Eye Hemorrhage/etiology , Humans , Infant , Inflammation/complications , Prevalence , Retrospective Studies
PURPOSE: To evaluate the efficacy of preoperative topical brimonidine use to maintain visibility during trabeculectomy and control intraoperative bleeding and postoperative subconjunctival hemorrhage. METHODS: The first group comprised 35 eyes of 34 patients administered brimonidine tartrate 0.15% (Brimogut, Bilim Ilac, Turkey) eye drops 6 and 3â min before surgery, and 33 eyes of 31 patients who received no medication for vasoconstriction formed the second group. Preoperative and postoperative photographs and operation video images were taken and vision analysis software used. Black-and-white images were obtained to identify the blood vessel and surface hemorrhage areas. The surface area of the hemorrhage was calculated by counting the black pixels with Image J software. RESULTS: There was no significant difference between two groups in terms of baseline (preoperative) eye redness (p > 0.05). In the first group, the eye redness values were 344.7 ± 19.5 pixels preoperatively and 244.1 ± 23.3 pixels at the beginning of the surgery, respectively (p < 0.001). However, no significant change was observed in the second group in eye redness (348.2 ± 17.5 pixels preoperatively and 360.7 ± 26.8 pixels at the beginning of the surgery, p > 0.05). Cautery was used for an average of 11.91 ± 1.96 s in the first group and 25.57 ± 4.66 s in the second to control intraoperative bleeding (P < 0.001). CONCLUSION: Preoperative topical brimonidine use in trabeculectomy surgery significantly decreased intraoperative bleeding and postoperative subconjunctival hemorrhage and facilitated bleeding control.
Conjunctival Diseases , Eye Hemorrhage , Trabeculectomy , Brimonidine Tartrate , Conjunctival Diseases/drug therapy , Conjunctival Diseases/etiology , Conjunctival Diseases/prevention & control , Eye Hemorrhage/drug therapy , Eye Hemorrhage/etiology , Eye Hemorrhage/prevention & control , Humans , Intraocular Pressure , Ophthalmic Solutions , Quinoxalines/therapeutic use
Eye Hemorrhage/etiology , Eye Infections, Bacterial/complications , Fluorescein Angiography/methods , Multifocal Choroiditis/complications , Tuberculosis, Ocular/complications , Eye Hemorrhage/diagnosis , Eye Infections, Bacterial/diagnosis , Fundus Oculi , Humans , Male , Middle Aged , Multifocal Choroiditis/diagnosis , Tuberculosis, Ocular/diagnosis
Conjunctival Diseases/etiology , Endocarditis, Bacterial/complications , Eye Hemorrhage/etiology , Mitral Valve Insufficiency/etiology , Streptococcal Infections/complications , Aged , Anti-Bacterial Agents/therapeutic use , Arthralgia/etiology , Arthralgia/physiopathology , Conjunctival Diseases/physiopathology , Echocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Esophagectomy , Eye Hemorrhage/physiopathology , Fever , Humans , Laryngectomy , Male , Mitral Valve Annuloplasty , Mitral Valve Insufficiency/surgery , Neoplasm Recurrence, Local , Pharyngeal Neoplasms/complications , Salvage Therapy , Squamous Cell Carcinoma of Head and Neck/complications , Streptococcal Infections/diagnosis , Streptococcal Infections/therapy , Streptococcus agalactiae , Tracheostomy , Wrist Joint
ABSTRACT A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.(AU)
RESUMO Uma paciente de 62 anos procurou nosso ambulatório com queixas de equimose periorbital e hemorragia subconjuntival, visíveis principalmente no olho direito. Descobrimos que suas queixas começaram no dia seguinte a um tratamento para dor de cabeça com sanguessugas na área da glabela. Na glabela, 2 mordidas de sanguessuga foram encontradas próximas ao lado direito. Durante os exames da paciente, foram detectadas equimoses nas pálpebras bilaterais e hemorragia subconjuntival no limbo ínfero lateral e medial do olho direito. Nenhum tratamento foi iniciado, sendo recomendado apenas controle. No acompanhamento, observou-se que as queixas da paciente desapareceram em cerca de um mês.(AU)
Middle Aged , Eye Hemorrhage/etiology , Conjunctiva/pathology , Leeching/adverse effects , Headache/drug therapy , Orbital Diseases , Hematoma
Contact Lenses , Corneal Diseases , Eye Hemorrhage , Corneal Diseases/diagnostic imaging , Corneal Diseases/etiology , Corneal Diseases/surgery , Corneal Injuries , Eye Hemorrhage/diagnostic imaging , Eye Hemorrhage/etiology , Eye Hemorrhage/surgery , Female , Humans , Middle Aged , Photography , Treatment Outcome
Abdominal Neoplasms/pathology , Eye Hemorrhage/etiology , Neuroblastoma/secondary , Orbital Neoplasms/secondary , Abdominal Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Cyclophosphamide/therapeutic use , Eye Hemorrhage/diagnostic imaging , Female , Humans , Infant , Neuroblastoma/complications , Neuroblastoma/diagnostic imaging , Neuroblastoma/drug therapy , Orbital Neoplasms/complications , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/drug therapy , Recurrence , Topotecan/therapeutic use , Treatment Outcome , Ultrasonography
RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.
ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.
Humans , Female , Middle Aged , Orbital Diseases/etiology , Orbital Diseases/diagnostic imaging , Barotrauma/complications , Eye Hemorrhage/etiology , Eye Hemorrhage/diagnostic imaging , Paranasal Sinus Diseases/drug therapy , Paranasal Sinus Diseases/diagnostic imaging , Aviation , Tomography, X-Ray Computed , Exophthalmos , Magnetic Resonance Angiography , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Diplopia , Air Travel
A preterm neonate with type 1 retinopathy of prematurity in posterior zone II presented with hemorrhage in Berger's space immediately after intravitreal bevacizumab injection. The authors report a rare case of successful self-resolution and discuss the need for proper injection technique to prevent this complication. [J Pediatr Ophthalmol Strabismus. 2020;57:e71-e73.].
Bevacizumab/adverse effects , Eye Hemorrhage/etiology , Retinopathy of Prematurity/drug therapy , Angiogenesis Inhibitors/administration & dosage , Angiogenesis Inhibitors/adverse effects , Bevacizumab/administration & dosage , Eye Hemorrhage/diagnosis , Humans , Infant, Newborn , Intravitreal Injections/adverse effects , Remission, Spontaneous , Vascular Endothelial Growth Factor A/antagonists & inhibitors
Craniopharyngioma/complications , Eye Hemorrhage/etiology , Papilledema/complications , Pituitary Neoplasms/complications , Visual Fields/physiology , Adult , Craniopharyngioma/diagnosis , Eye Hemorrhage/diagnosis , Eye Hemorrhage/physiopathology , Humans , Magnetic Resonance Imaging , Male , Papilledema/diagnosis , Papilledema/physiopathology , Pituitary Neoplasms/diagnosis
Spontaneous unilateral orbital haematoma in children is not common and very rarely caused by scurvy. Scurvy is a clinical syndrome with a spectrum of clinical manifestations due to severe prolonged vitamin C deficiency leading to impairment of collagen synthesis over skin, bone, teeth and blood vessels. This paper presents a unique case of a 7- year-old girl with learning difficulty who presented with spontaneous right proptosis due to scurvy. Imaging studies suggestive of intra- orbital extraconal haemorrhage. The child was treated with a higher than recommended dose of vitamin C initially in emergency situation. She responded well and discharged without complication. Spontaneous orbital haematoma due to scurvy is very rare with less than 10 cases published in literature. The present case should raise the awareness regarding this forgotten disease and importance of balance nutrition amongst children.
Exophthalmos/etiology , Eye Hemorrhage/etiology , Hematoma/etiology , Scurvy/diagnosis , Child , Exophthalmos/diagnosis , Eye Hemorrhage/diagnosis , Female , Hematoma/diagnosis , Humans , Scurvy/complications
