Differential Diagnosis for 74-year-old Female with Bilateral Subconjunctival Bleeding
- Single most likely diagnosis:
- Hypertension: Although the patient reports well-controlled blood pressure, the presence of bilateral subconjunctival bleeding and distended superficial veins could suggest uncontrolled or episodic hypertension. The lack of recent trauma or other symptoms makes this a plausible explanation.
- Other Likely diagnoses:
- Age-related vascular fragility: As people age, their blood vessels become more fragile and prone to rupture, which could explain the spontaneous subconjunctival bleeding.
- Dry eye syndrome: This condition can cause irritation and increased risk of subconjunctival hemorrhage, especially in older adults.
- Blepharitis or conjunctivitis: Inflammation of the eyelids or conjunctiva could lead to increased risk of bleeding, although the patient denies recent URI symptoms or cough.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Giant Cell Arteritis: Although less common, this condition can cause sudden vision changes, headache, and jaw claudication, but it may also present with less typical symptoms such as subconjunctival bleeding.
- Carotid-cavernous fistula: An abnormal connection between the carotid artery and cavernous sinus could cause increased pressure and bleeding in the eyes, although this would typically be accompanied by other symptoms like pulsatile exophthalmos.
- Intracranial hemorrhage or vascular malformation: Rarely, subconjunctival bleeding could be a sign of increased intracranial pressure or a vascular anomaly, which would require urgent evaluation.
- Rare diagnoses:
- Amyloidosis: This condition can cause vascular fragility and bleeding, including subconjunctival hemorrhage, although it is relatively rare.
- Scurvy: Vitamin C deficiency can cause blood vessel fragility and bleeding, including subconjunctival hemorrhage, but this is uncommon in developed countries.
- Malignancy: Rarely, subconjunctival bleeding could be a sign of an underlying malignancy, such as a lymphoma or metastatic disease, although this would typically be accompanied by other symptoms.