Pediatric emergency medicine trisk 0586 0586
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FIGURE 27.7 Subconjunctival hemorrhage.
If the injection is localized, the examiner should consider a specific list of
diagnostic possibilities. Subconjunctival hemorrhage is characterized by
localized, sharply circumscribed acute redness ( Fig. 27.7 ). There is no pain,
visual disturbance, or discharge. It is uncommon in children who do not have a
history of a direct blow to the eye. Subconjunctival hemorrhage in a young child
should prompt consideration for a coagulopathy workup, or the possibility of
nonaccidental trauma or suffocation. Pertussis infection can result in 360-degree
unilateral or even bilateral prominent subconjunctival hemorrhage, which is not
expected to occur with other causes of cough. Conjunctival petechia can rarely be
seen after strong Valsalva but usually with additional petechia elsewhere on the
face. Herpes keratitis phlyctenule, episcleritis, and scleritis may present with
focal involvement, as previously discussed. Localized injection of the conjunctiva
may be an indicator of an embedded foreign body, varicella, or other focal
processes that require an ophthalmologic consultation.
Acute acquired glaucoma causes a painful red eye, sometimes associated with
corneal clouding and decreased visual acuity. Acquired glaucoma, is most often
associated with trauma, other anatomic abnormalities, or iritis that would be
apparent on examination. Because it is difficult to determine intraocular pressure
in children, ophthalmologic consultation may be required if emergency medicine
providers do not have experience with this procedure.
