Approach Considerations

Laboratory studies are not required for most patients. Check visual acuity, IOP, and blood pressure in every patient.

The diagnosis of scleritis and iritis generally requires further workup for associated systemic disease, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), and levels of antinuclear antibody (ANA), rheumatoid factor (RF), uric acid, and rapid plasma reagin (RPR). Uncomplicated episcleritis and iritis warrant further evaluation if more than one episode occurs. Send exudate from patients with conjunctivitis for bacterial culture, especially in cases of corneal ulceration or significant conjunctival disease.

In the setting of potential subconjunctival hemorrhage, if there is a history of trauma, rule out a ruptured globe or retrobulbar hemorrhage.^[19]If the condition is recurrent or there is a history of bleeding problems (eg, epistaxis or easy bruising), then bleeding time, prothrombin time (PT), activated partial thromboplastin time (aPTT), CBC with platelets, and protein C and S levels should be obtained, and consultation with an internist should be considered.^[11]

Treatment & Management

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Quezada AA, Shields CL, Wagner RS, Demirci H, Caputo AR, Shields JA. Lymphangioma of the conjunctiva and nasal cavity in a child presenting with diffuse subconjunctival hemorrhage and nosebleeds. J Pediatr Ophthalmol Strabismus. 2007 May-Jun. 44(3):180-2. [QxMD MEDLINE Link].
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Mimura T, Usui T, Yamagami S, Funatsu H, Noma H, Honda N, et al. Recent causes of subconjunctival hemorrhage. Ophthalmologica. 2010. 224(3):133-7. [QxMD MEDLINE Link].
Mimura T, Yamagami S, Mori M, Funatsu H, Usui T, Noma H, et al. Contact lens-induced subconjunctival hemorrhage. Am J Ophthalmol. 2010 Nov. 150(5):656-665.e1. [QxMD MEDLINE Link].
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Fraunfelder FT. Drug Induced Ocular Side Effects and Drug Interactions. 3rd ed. Philadelphia: Lea & Febiger; 1989.
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A V P, Patil SS, Koti SV, J S A, Garag SS, Hegde JS. Clinico-bacteriological study of chronic dacryocystitis cases in northern karnataka, India. J Clin Diagn Res. 2013 Nov. 7 (11):2502-4. [QxMD MEDLINE Link].
Moore JE, Graham JE, Goodall EA, Dartt DA, Leccisotti A, McGilligan VE, et al. Concordance between common dry eye diagnostic tests. Br J Ophthalmol. 2009 Jan. 93(1):66-72. [QxMD MEDLINE Link].
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Media Gallery

Follicular conjunctivitis and subconjunctival hemorrhage.
Symblepharon secondary to epidemic keratoconjunctivitis.
Blepharitis. Courtesy of Wikipedia Commons.
Scleritis. Courtesy of Wikipedia Commons.
Acute dacryocystitis.
Canaliculitis of the left lower lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
Corneal abrasion.
This photograph depicts a child with a bilateral eye condition known as interstitial keratitis (IK), a stigma related to congenital syphilis.
Conjunctivitis. Courtesy of Wikipedia Commons.

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Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Arizona Ophthalmological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Vivian R Monsanto, MD Clinical Instructor, Department of Ophthalmology, New York University Grossman School of Medicine; Ophthalmologist, NYU Langone Health

Vivian R Monsanto, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Acknowledgements

Gino A Farina, MD Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine

Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine