Acute onset, red eye and cough


• Albuterol trial


• Discharged


• Brock Daniels, MD Yale School of Medicine


• Andy Barnett, MD Assistant Professor of Emergency Medicine Oregon Health and Science University
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Conjunctival hemorrhage

Differential Diagnosis

• Subconjunctival hemorrhage
• Scleral abrasion/laceration
• Supratherapeutic INR

Patient Workup

• History
• Physical exam
• Labs including INR; CXR

Key Points

• Subconjunctival hemorrhage occurs as a result of bleeding from small conjunctival vessels.
• Usually results from minor eye trauma or increased venous pressure (Valsalva) such as from coughing, straining, vomiting or sneezing.
• More common in diabetics, hypertensives, patients on anticoagulants, contact lens wearers and trauma patients.
• If history of trauma, serious injury such as scleral or corneal laceration and globe rupture should be ruled out. Pain, visual changes or the presence of hyphema suggest complex injury.

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