From the Guidelines
For a geriatric patient with a subconjunctival hemorrhage accompanied by itching, the primary approach should focus on reassurance and symptomatic relief, as this condition typically resolves on its own within 1-2 weeks without specific intervention. The itching, which may be due to associated conjunctival irritation or a separate issue like dry eye, can be managed with artificial tears such as Systane or Refresh used 4-6 times daily 1. Additionally, a cool compress applied to the closed eye for 10 minutes several times daily may help reduce discomfort.
- Key considerations in management include:
- Avoiding eye rubbing to prevent worsening the hemorrhage
- Using preservative-free antihistamine eye drops like ketotifen 0.025% (Zaditor) twice daily for 3-5 days if itching is severe
- Advising the patient on the benign nature of subconjunctival hemorrhages but also on the importance of monitoring for resolution and potential underlying conditions
- It's crucial to note that while the condition is generally benign, certain factors such as the use of blood thinners, recurrent hemorrhages, vision changes, or pain necessitate further evaluation to rule out underlying conditions like hypertension, blood disorders, or other ocular pathologies, as highlighted in the approach to treating conjunctivitis and other eye conditions 1.
- The treatment should be directed at the root cause, and indiscriminate use of topical antibiotics or corticosteroids should be avoided due to potential toxicity and adverse effects on certain infections, as emphasized in the conjunctivitis preferred practice pattern 1.
From the Research
Treatment and Management of Subconjunctival Hemorrhage
The treatment and management of subconjunctival hemorrhage, which may be the cause of the itchy eye and popped blood vessel in the geriatric patient, can be approached in several ways:
- The patient's medical history and ocular history should be thoroughly examined to determine the cause of the subconjunctival hemorrhage, as it can be a sign of a systemic disorder 2.
- Hypertension is a major risk factor for subconjunctival hemorrhage in older patients, so blood pressure should be monitored and managed if necessary 3.
- A comprehensive work-up of the patient, including a thorough case history, should be performed to rule out trauma, infection, medications, or systemic disease as the causative agent 4.
Relief of Itchy Eye Symptoms
For relief of itchy eye symptoms, oral antihistamines such as loratadine may be considered, as they do not have a significant effect on tear volume or intraocular pressure 5.
- However, diphenhydramine should be used with caution, as it can decrease tear volume.
- Topical antibiotics and artificial tears may also be associated with reduced infective-conjunctivitis symptoms, but their use should be determined on a case-by-case basis 6.
Important Considerations
It is essential to note that subconjunctival hemorrhage can be caused by various entities, each with its own important sequelae, and a thorough investigation should be conducted to determine the underlying cause 2, 3, 4.