Coughing Kid and a Blood Red Eye
aka Ophthalmology Befuddler 006
A 14 year-old boy is brought into the emergency department by his weary mother. He has been keeping everyone awake at night with his incessant coughing. That, however, is not why they are here today. She is worried about bleeding under the surface of his eye.
Questions
Q1. What is shown?
Answer and interpretation
Subconjunctival hemorrhage.
Q2. What are the possible causes?
Answer and interpretation
Subconjunctival hemorrhages may be related to minor injuries such as rubbing the eye or coughing. It is more common in those with a bleeding diathesis or those taking anticoagulants and antiplatelet agents.
Subconjunctival can also coexist with more serious ocular or orbital trauma — this needs to be ruled out. A subconjunctival haemorrhage with out inferior limit may be caused by a base of skull fracture.
Q3. What features on history and examined should be looked for?
Answer and interpretation
History:
- minor trauma, coughing, bleeding diathesis
- rule out major trauma (e.g. base of skull fracture).
Examination:
- unilateral, localised and sharply demarcated confluent blood red discoloration with mobile overlying conjunctiva.
- No evidence of inflammation, pain or discharge.
- Normal visual acuity, red reflex and fundoscopy — rule out coexisting serious ocular or orbital trauma.
Q4. What is the appropriate management?
Answer and interpretation
- Check blood pressure and assess for a bleeding diathesis (e.g. FBC and coags) as required.
- Apply lubrication if needed, e.g. artificial tears.
- Refer if pain develops or condition worsens.
References
- Ehlers JP, Shah CP, Fenton GL, Hoskins EN. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease Lippincott Williams & Wilkins
- NSW Statewide Opthalmology Service. Eye Emergency Manual — An illustrated Guide. [Free PDF]
OPHTHALMOLOGY BEFUDDLER
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC