ECCHYMOSIS OF CONJUNCTIVA

Ecchymosis or subconjunctival haemorrhage (one of SYMPTOMATIC CONDITIONS OF CONJUNCTIVA) is of very common occurrence. It may vary in extent from small petechial haemorrhage to an extensive one
spreading under the whole of the bulbar conjunctiva and thus making the white sclera of the eye invisible. The condition though draws the attention of the patients immediately as an emergency but is most of the time trivial.

Etiology. Subconjunctival haemorrhage may be associated with following conditions:
1. Trauma. It is the most common cause of
subconjunctival haemorrhage. It may be in the
form of (i) local trauma to the conjunctiva including

that due to surgery and subconjunctival
injections, (ii) retrobulbar haemorrhage which
almost immediately spreads below the bulbar
conjunctiva. Mostly, it results from a retrobulbar
injection and from trauma involving various walls
of the orbit.
2. Inflammations of the conjunctiva. Petechial
subconjunctival haemorrhages are usually associated with acute haemorrhagic conjunctivitis
caused by picornaviruses, pneumococcal
conjunctivitis and leptospirosis, icterohaemorrhagica
conjunctivitis.
3. Sudden venous congestion of head. The
subconjunctival haemorrhages may occur owing
to rupture of conjunctival capillaries due to sudden
rise in pressure. Common conditions are whooping
cough, epileptic fits, strangulation or compression
of jugular veins and violent compression of thorax
and abdomen as seen in crush injuries.
4. Spontaneous rupture of fragile capillaries may
occur in vascular diseases such as arteriosclerosis,
hypertension and diabetes mellitus.
5. Local vascular anomalies like telengiectasia,
varicosities, aneurysm or angiomatous tumour.
6. Blood dyscrasias like anaemias, leukaemias and
dysproteinaemias.
7. Bleeding disorders like purpura, haemophilia and
scurvy.
8. Acute febrile systemic infections such as malaria,
typhoid, diphtheria, meningococcal septicaemia,
measles and scarlet fever.
9. Vicarious bleeding associated with menstruation
is an extremely rare cause of subconjunctival
haemorrhage.

Clinical features. Subconjunctival haemorrhage per SE is symptomless.

  However, there may be symptoms of associated causative disease. On examination subconjunctival haemorrhage looks as a flat sheet of
homogeneous bright red colour with well defined limits (Fig. 1). In traumatic subconjunctival haemorrhage, posterior limit is visible when it is due to local trauma to eyeball, and not visible when it is due to head injury or injury to the orbit. Most of the time it is absorbed completely within 7 to 21 days. During absorption colour changes are noted from bright red to orange and then yellow. In severe cases, some pigmentation may be left behind after
absorption.

Fig.1. Subconjunctival haemorrhage.

Treatment. (i) Treat the cause when discovered. (ii) Placebo therapy with astringent eye drops. (iii) Psychotherapy and assurance to the patient is most
important part of treatment. (iv) Cold compresses to heck the bleeding in the initial stage and hot compresses may help in absorption of blood in late
stages.