Subconjunctival Hemorrhage vs Traumatic Hyphema
Subconjunctival Hemorrhage and Traumatic Hyphema are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Subconjunctival Hemorrhage vs Traumatic Hyphema at a glance
- Subconjunctival Hemorrhage: Painless flat bright-red blood under conjunctiva — self-limited; investigate trauma, anticoagulation, or recurrence.
- Traumatic Hyphema: Blood in the anterior chamber after blunt trauma — risk of rebleed (days 2-5), elevated IOP, and corneal staining; head up, eye shield, sickle screen.
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Side-by-side comparison
| Feature | Subconjunctival Hemorrhage | Traumatic Hyphema |
|---|---|---|
| At a glance | Painless flat bright-red blood under conjunctiva — self-limited; investigate trauma, anticoagulation, or recurrence. | Blood in the anterior chamber after blunt trauma — risk of rebleed (days 2-5), elevated IOP, and corneal staining; head up, eye shield, sickle screen. |
| Classic presentation | Painless, flat, well-demarcated bright-red patch under the conjunctiva with normal vision and pupil.; Bright red patch noticed by patient or pointed out by family — often on awakening; PAINLESS — mild scratchy or pressure sensation at most; Normal vision; No discharge; May report preceding cough, sneeze, vomiting, lifting, straining, or… | Layered blood in the anterior chamber after blunt trauma, with elevated IOP and reduced acuity.; Pain, blurred vision, and history of recent blunt or penetrating eye trauma; Photophobia; Headache, nausea, or vomiting may indicate elevated intraocular pressure; Diplopia or restricted motility suggests orbital fracture or muscle… |
| Workup / key labs | None needed for isolated event in a well patient; If recurrent or atypical: CBC, PT/INR, PTT, platelets, liver function; consider von Willebrand workup if suggestive bleeding history; Blood pressure measurement is essential | Clinical diagnosis by slit-lamp examination demonstrating red blood cells in the anterior chamber after trauma.; Sickle cell screen (Sickledex) and hemoglobin electrophoresis if African, Caribbean, Mediterranean, Middle Eastern, or South Asian ancestry — sickling in the AC even with trait can elevate IOP dangerously and limit medication… |
| Imaging | No imaging required for typical isolated SCH; If trauma — examine for hyphema, ruptured globe; CT orbits if orbital fracture or intraocular foreign body suspected | Slit-lamp examination and measurement of IOP (gentle, after ruling out open globe); Dilated fundoscopy and B-scan ultrasound if media opacity prevents posterior segment view (and globe is intact) to evaluate for vitreous hemorrhage, retinal detachment, or intraocular foreign body; CT orbits without contrast if orbital fracture, retained… |
| First-line treatment | Reassurance — SCH is benign and self-resolves over 1-2 weeks; color fades through red → yellow before disappearing; Artificial tears for any mild irritation; Cold compresses initially (24-48 h) followed by warm compresses can speed perceived resolution; Avoid aspirin/NSAIDs and vigorous activity if recent or extensive (clinical… | Protect the eye with a rigid metal or plastic shield (NOT a patch with pressure); Strict bed rest or limited activity with elevation of the head of bed to 30-45 degrees to promote settling of blood inferiorly and prevent obstruction of the visual axis and trabecular meshwork; Avoid NSAIDs and aspirin (rebleed risk); use acetaminophen… |
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