Subconjunctival Hemorrhage
The most likely diagnosis is D. Subconjunctival hemorrhage – a benign condition presenting as a bright red spot in the eye without pain, visual changes, or signs of infection, particularly common in hypertensive patients 1.
Clinical Presentation
Subconjunctival hemorrhage appears as a bright red patch on the white of the eye caused by bleeding beneath the conjunctiva, and is characteristically painless with preserved vision 1.
The condition is a benign disorder and represents one of the most common causes of acute ocular redness in clinical practice 1.
Among elderly patients, systemic vascular diseases such as hypertension are the most common risk factors for subconjunctival hemorrhage, making this diagnosis particularly fitting for a hypertensive man 1.
Why Not the Other Options
Conjunctivitis (A) typically presents with discharge, irritation, and injection of the conjunctival vessels rather than a discrete bright red patch, and the patient explicitly has no signs of infection 1.
Scleritis (B) is a serious inflammatory condition that causes severe, boring eye pain (often described as waking patients from sleep), reduced vision, and tenderness to palpation – none of which are present in this case 1.
Episcleritis (C) presents with mild discomfort or irritation and sectoral redness, but typically causes some degree of ocular discomfort, which this patient denies 1.
Important Clinical Context
While subconjunctival hemorrhage is benign in most cases, recurrent or persistent episodes warrant further evaluation including workup for systemic hypertension, bleeding disorders, and medication side effects (particularly anticoagulants) 1.
The patient's hypertension is a significant risk factor, but this presentation does not represent hypertensive retinopathy, which would require fundoscopic examination and would show flame-shaped hemorrhages, cotton wool spots, or papilledema in severe cases 2, 3.
Hypertensive retinopathy affecting the retina (not visible without fundoscopy) is distinctly different from subconjunctival hemorrhage (visible bright red patch on the eye surface) 2, 3.
Management Approach
Reassurance is the primary management, as subconjunctival hemorrhages typically resolve spontaneously within 1-2 weeks without treatment 1.
Ensure adequate blood pressure control given the patient's hypertension, as this is a modifiable risk factor 1.
If hemorrhages are recurrent, investigate for bleeding disorders, anticoagulant use, and ensure hypertension is well-controlled 1.