From the Research
The appropriate management for conjunctival petechiae typically involves addressing the underlying cause rather than treating the petechiae themselves, as they are usually benign and resolve spontaneously without specific treatment. When considering the management of conjunctival petechiae, it is crucial to prioritize the identification of the underlying cause, as this will guide the most effective treatment approach. Some key points to consider in the management of conjunctival petechiae include:
- A thorough history and examination to identify potential causes such as trauma, coughing, vomiting, strangulation, or systemic conditions like thrombocytopenia or coagulopathies 1
- If the petechiae resulted from minor trauma or Valsalva maneuvers, reassurance can be provided as they will typically resolve within 1-2 weeks without intervention
- Artificial tears may be prescribed for any associated discomfort, using preservative-free formulations 4-6 times daily
- For petechiae associated with infectious conjunctivitis, treating the underlying infection with appropriate antibiotics like polymyxin B-trimethoprim drops or erythromycin ointment may be necessary, as supported by a systematic review of diagnosis and treatment of conjunctivitis 2
- If petechiae are extensive, recurrent, or accompanied by systemic symptoms, further investigation including complete blood count, coagulation studies, and possibly referral to hematology may be warranted
- The presence of conjunctival petechiae in the context of trauma to the neck or face should raise suspicion for non-accidental injury or strangulation, particularly in vulnerable populations, and may require appropriate reporting and intervention, with consideration of the pathogenesis of conjunctival petechiae as a rhexis-haemorrhage 3.