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A subconjunctival hemorrhage or hematoma (SCH) may be a minor non–vision-threatening finding, or it could be associated with a major vision-threatening injury. SCH may occur with trivial events such as a cough, sneeze, Valsalva maneuver, or minor blunt trauma. The blood is usually bright red and sharply circumscribed and appears flat. It is limited to the bulbar conjunctiva and stops abruptly at the limbus. This appearance is important to differentiate from bloody chemosis, which can occur with scleral rupture or nontraumatic conditions. Uncomplicated SCH does not usually cause pain or diminution in visual acuity.
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Management and Disposition
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No treatment is required. Instruct the patient to expect the blood to resorb within 2 to 3 weeks.
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Elevated, dense, circumferential SCH should prompt evaluation for bleeding diathesis or globe rupture.
SCH involving the extreme lateral globe after blunt trauma is very suspicious for zygomatic arch fracture.
Evaluate patients with nontraumatic bloody chemosis for an underlying metabolic (coagulopathy) or structural (cavernous sinus thrombosis) disorder.
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