A 34-year-old male presents to the emergency department with a red eye. He says, "I just woke up this morning and saw that my right eye was red." He denies any itching, pain or discharge. He has no known drug or environmental allergies. He takes no medication. His vital signs are stable. The photo of his eye is shown below. What is the best next step in his management?

Question

A 34-year-old male presents to the emergency department with a red eye.  He says, "I just woke up this morning and saw that my right eye was red."  He denies any itching, pain or discharge.  He has no known drug or environmental allergies.  He takes no medication.  His vital signs are stable.  The photo of his eye is shown below.  What is the best next step in his management?

Quizplus · Accepted Answer

This patient has a subconjunctival hemorrhage. He woke up with a red eye, and is entirely asymptomatic. Subconjunctival hemorrhage is a completely benign condition. It may be due to simple trauma from rubbing the eyes vigorously, violent coughing spells, hypertensive episodes or coagulopathy. In the majority of cases, the condition is from minor bruising and does not require any workup at all. The hemorrhage usually disappears in 24 to 48 hours. Simple observation is the best treatment. The occasional patient with subconjunctival hemorrhage may have an elevated blood pressure. In such rare cases, lowering of the blood pressure may be useful. (Choice A) The intraocular pressure is usually monitored in individuals with suspected glaucoma. Features of glaucoma include visual loss, pupillary dilatation and erythema around the conjunctiva. The eyeball may feel hard to palpation. A tonometer reveals the increased intraocular pressure. The treatment is a topical cholinergic or beta blocker eye drops. (Choice B) There is no need for an ophthalmology referral at this time. Subconjunctival hemorrhage is a very benign condition. (Choice C) The occasional patient who is on anticoagulation medication may develop a subconjunctival hemorrhage. Measurements of coagulation parameters may be indicated in such a case. Therapy is conservative. (Choice E) Antibiotics are not required for subconjunctival hemorrhage because the condition is not infectious. Conjunctivitis can present with discharge and redness of the eye. Topical antibiotic drops are required. Educational Objective: Spontaneous subconjunctival hemorrhage is a benign finding, and does not require any treatment.

A 34-Year-Old Male Presents to the Emergency Department with a Red