Differential Diagnosis for Subconjunctival Hemorrhage
- Single most likely diagnosis
- Hypertension: This is often the most common cause of spontaneous subconjunctival hemorrhage, especially in older adults, due to the rupture of small blood vessels under the conjunctiva.
- Other Likely diagnoses
- Trauma: Direct injury to the eye can cause subconjunctival hemorrhage by rupturing the small blood vessels under the conjunctiva.
- Bleeding disorders (e.g., hemophilia, thrombocytopenia): Conditions that affect blood clotting can increase the risk of subconjunctival hemorrhage.
- Anticoagulant use: Medications that prevent blood clotting, such as warfarin or aspirin, can increase the risk of subconjunctival hemorrhage.
- Sudden increase in pressure (e.g., coughing, sneezing, straining): These actions can increase pressure in the small blood vessels under the conjunctiva, leading to rupture.
- Do Not Miss diagnoses
- Orbital cellulitis or abscess: Although rare, these conditions can cause subconjunctival hemorrhage and are medical emergencies requiring prompt treatment.
- Malignant hypertension: Severe uncontrolled hypertension can lead to subconjunctival hemorrhage and indicates a need for immediate blood pressure management.
- Vasculitis (e.g., giant cell arteritis, polyarteritis nodosa): Inflammatory conditions affecting blood vessels can cause subconjunctival hemorrhage and require specific treatment.
- Rare diagnoses
- Amyloidosis: Deposits of abnormal proteins (amyloid) in the blood vessels under the conjunctiva can weaken them and lead to hemorrhage.
- Scurvy (Vitamin C deficiency): This condition can cause blood vessel fragility, leading to subconjunctival hemorrhage among other symptoms.
- Ehlers-Danlos syndrome: A genetic disorder affecting connective tissue, which can lead to fragile blood vessels and increased risk of subconjunctival hemorrhage.