Differential Diagnosis for a 63-year-old Male with Minor Subscleral Hematoma

Single Most Likely Diagnosis

• Aspirin-induced bleeding: The patient is on daily aspirin, which is a well-known antiplatelet agent that can increase the risk of bleeding, including minor hemorrhages like a subscleral hematoma. The use of aspirin can impair platelet aggregation, making it more difficult for the body to form clots and stop bleeding.

Other Likely Diagnoses

• Hypertension: Uncontrolled high blood pressure can lead to blood vessel fragility and rupture, resulting in hemorrhages, including subscleral hematoma.
• Trauma: Minor trauma to the eye, even if not immediately apparent, can cause a subscleral hematoma.
• Bleeding disorders (e.g., thrombocytopenia, von Willebrand disease): Although less common, underlying bleeding disorders could predispose the patient to hematoma formation, especially if there's a history of easy bruising or bleeding.

Do Not Miss Diagnoses

• Intracranial hemorrhage: Although the presentation is with a subscleral hematoma, it's crucial to consider the possibility of an intracranial hemorrhage, especially in someone on anticoagulant therapy. This condition is life-threatening and requires immediate medical attention.
• Orbital hemorrhage: A more severe condition that could present similarly but requires urgent intervention to prevent vision loss or other complications.
• Vascular malformations or tumors: Rarely, a subscleral hematoma could be the first sign of a vascular malformation or tumor, which would have significant implications for treatment and prognosis.

Rare Diagnoses

• Amyloidosis: Systemic amyloidosis can cause bleeding due to vascular fragility and could potentially lead to a subscleral hematoma, although this would be extremely rare and typically part of a broader clinical picture.
• Scurvy: Vitamin C deficiency can lead to blood vessel fragility and bleeding, including hemorrhages like a subscleral hematoma, but this is rare in developed countries.
• Leukemia or lymphoma: Certain types of cancer can increase the risk of bleeding due to bone marrow suppression or direct effects on blood vessels, but these would typically be associated with other systemic symptoms.

Best Treatment Approach

The best initial treatment for a minor subscleral hematoma, especially in the context of aspirin use, would involve discontinuing aspirin if possible and applying cold compresses to reduce swelling. Monitoring for any signs of worsening, such as increased pain, vision changes, or significant swelling, is crucial. If the hematoma is large, interferes with vision, or if there are concerns about underlying conditions, further evaluation with imaging (e.g., CT or MRI) and consultation with an ophthalmologist or other specialists may be necessary.