Differential Diagnosis for Scleral Hematoma without Trauma and Pain
- Single most likely diagnosis
- Subconjunctival hemorrhage: This condition is characterized by the accumulation of blood underneath the conjunctiva, often without any apparent trauma. It can cause a scleral hematoma appearance and is usually painless.
- Other Likely diagnoses
- Anticoagulant use: Patients on anticoagulant therapy may experience spontaneous bleeding, including scleral hematoma, due to their altered coagulation status.
- Hypertension: Uncontrolled high blood pressure can lead to vascular rupture and subsequent bleeding, potentially causing a scleral hematoma.
- Scleritis: Although typically painful, some forms of scleritis (e.g., posterior scleritis) may present with minimal pain and could be associated with a scleral hematoma.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Orbital tumor: A tumor in the orbit can cause erosion of blood vessels, leading to spontaneous bleeding, including a scleral hematoma.
- Vascular malformation: Abnormal blood vessels, such as arteriovenous malformations, can rupture and cause bleeding, which may manifest as a scleral hematoma.
- Inflammatory or infectious diseases (e.g., endophthalmitis, orbital cellulitis): These conditions can cause severe inflammation and potentially lead to vascular rupture and bleeding.
- Rare diagnoses
- Amyloidosis: This condition can cause vascular fragility and increase the risk of spontaneous bleeding, including scleral hematoma.
- Scurvy: Vitamin C deficiency can lead to blood vessel fragility and increased risk of bleeding, potentially causing a scleral hematoma.
- Ehlers-Danlos syndrome: This genetic disorder affects connective tissue and can increase the risk of vascular rupture and bleeding, including scleral hematoma.