نزيف أسفل الملتحمة

النزيف أسفل الملتحمة
الأسماء الأخرى	Subconjunctival hemorrhage, subconjunctival haemorrhage, hyposphagma
Subconjunctival hemorrhage resulting in red coloration of the white of the eye.
التخصص	Ophthalmology, Optometry
الأعراض	Red spot over whites of the eye, little to no pain
المضاعفات	None
المدة	Two to three weeks
الأنواع	Traumatic, spontaneous
المسببات	Coughing, vomiting, direct injury
عوامل الخطر	High blood pressure, diabetes, older age
الطريقة التشخيصية	Based on the appearance
التشخيص المفاضل	Open globe, retrobulbar hematoma, conjunctivitis, pterygium
العلاج	No specific treatment
الدواء	Artificial tears
Prognosis	Good, 10% risk of reoccurance
التردد	شائع

النزيف أسفل الملتحمة (إنگليزية: Subconjunctival bleeding أو إنگليزية: subconjunctival hemorrhage)، أو إنگليزية: subconjunctival haemorrhage)، هو نزيف is bleeding from a small blood vessel over the whites of the eye. It results in a red spot in the white of the eye. There is generally little to no pain and vision is not affected. Generally only one eye is affected.

Natural causes can include coughing, vomiting, heavy lifting, straining to pass hard stools during acute constipation or the act of "pushing" or "bearing down" during labour/childbirth as these activities can increase the blood pressure in the vascular systems supplying the retina. There are up to four vascular retinal plexuses that are supplied by tiny, delicate capillaries whose walls if encountered with a sudden amount of force from blood will rupture. External causes can include direct impact/injury from an accidental bump or a physical altercation resulting in blunt force trauma. Risk factors include hypertension, diabetes, old age, and blood thinners. They occur in about 2% of newborns following a vaginal delivery. The blood occurs between the conjunctiva and the episclera. Diagnosis is generally based on the appearance.

Generally no specific treatment is required and the condition improves in two to three weeks. Artificial tears may be used to help with any irritation. They occur relatively commonly. Both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males.

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 الأعراض والعلامات

A subconjunctival bleeding usually does not result in pain, although occasionally the affected eye may feel dry, rough, or scratchy.

A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within 2 weeks.

• 

  After one week

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  Same as prior after four weeks

• 

  As viewed through a slit lamp

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  After 48 hours

 الأسباب

• It may result from being strangled
• Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
• Mask squeeze from diving and not equalizing mask pressure during descent
• Eye trauma
• Coagulation disorder (congenital or acquired) including Ebola
• Head injury
• Whooping cough or other extreme sneezing or coughing
• Severe hypertension
• LASIK
• Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
• Leptospirosis
• Increased venous pressure (e.g., extreme g-force, straining, vomiting, choking, or coughing) or from straining due to constipation
• Zygoma fracture (results in lateral subconjunctival bleeding)

Subconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency), abuse or traumatic asphyxia syndrome.

Eye surgery such as LASIK, and atmospheric pressure changes such as those from diving deeply in water and aircraft altitude changes.

 التشخيص

Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye.

 العلاج

A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged.

 وصلات خارجية

Classification	V · T · D ICD-10: H11.3 ICD-9-CM: 372.72
External resources	MedlinePlus: 001616 Patient UK: نزيف أسفل الملتحمة