[Traumatic subconjuntival hemorrhage. Presentation and associated injuries]

Subconjunctival hemorrhage is frequent in ocular trauma and is traditionally left untreated, awaiting spontaneous resolution unless associated with open globe injury. A study was performed to identify characteristics of eyes with subconjunctival hemorrhage, rate of coexisting additional injuries, and whether visual acuity might allow detection of the latter.

Patients evaluated for ocular trauma at our service between 1996 and 2000 with subconjunctival hemorrhage were included; eyes without visual acuity record were eliminated. Each eye was re-qualified according to standardized classification of ocular trauma. Presence of additional ocular injuries in eyes with different grade (visual acuity) was recorded. Rate of additional injuries by grade was compared with chi-square and odds ratio (OR).

A total of 178 eyes of 168 patients aged 1 to 84 years (average 27.63 years, standard deviation (SD) 17.3) were evaluated; grade (visual acuity) was 1 in 107 eyes (60.1%), 2 in 35 (19.7%), 3 in 22 (12.3%), 4 in 11 (6.2%) and 5 in three (1.7%) eyes. Seventy six eyes had additional injuries (42.7%, 95% confidence interval [CI 95%] 35.5-49.9%). A higher proportion of additional injuries was found in patients with grade < 1 (66.2%) than in those with grade 1 (27.1%, p < 0.001 OR 5.27, 95% CI 2.72-10.68).

A high rate of patients with subconjunctival hemorrhage presented additional injuries. Visual acuity < 1 increased probability of having additional damage. It is suggested that visual acuity be evaluated in every injured eye, even when diagnosis of subconjunctival hemorrhage is evident and data of open globe absent, to help detect eyes that require specialized evaluation.