Subconjunctival hemorrhage

Ocular Effects. One case study describes eye irritation in two individuals exposed to JP-5 vapor for approximately 1 hour while flying a small airplane (Porter 1990). Both individuals experienced a burning sensation in their eyes, and one had itchy, watery eyes 1 day after the exposure. These effects subsided within 24 hours. Hyperemic conjunctiva were also reported for one of the individuals this effect subsided after 4 days. Another case study describes subconjunctival hemorrhages in a man who had washed his hair with an unknown amount of diesel fuel (Barrientos et al. 1977). Effects resulting from inhalation versus dermal exposure could not be distinguished in this case. Eye irritation was not induced in six volunteers by a 15-minute exposure to 140 mg/m deodorized kerosene vapor (Carpenter et al. 1976). 

Ocular Effects. JP-5 vapor were irritating to the eyes of two individuals and were associated with hyperemic conjunctiva in one case (Porter 1990). Eye irritation was also reported in workers who were chronically exposed to unspecified jet fuels, which may or may not include JP-5 (Knave et al. 1978). Deodorized kerosene vapor were shown to induce eye irritation in some individuals (Carpenter et al. 1976). Dermal exposure to diesel fuel and/or inhalation of its vapor was associated with subconjunctival hemorrhages in an individual who used it as a shampoo (Barrientos et al. 1977). In the only available animal studies, rabbits exposed dermally to diesel fuel (API 1979b), marine diesel fuel, or JP-5 (Cowan and Jenkins 1981 Schultz et al. 1981) showed no signs of ocular irritation. These data suggest that fuel oils, in general, may induce eye irritation in some individuals, although only one or two individuals... 

Abnormal vision, cataract, conjunctivitis, dry eye, eye disorder, flare, iris discoloration, keratitis, lid margin crusting, photophobia, subconjunctival hemorrhage, and tearing... 

AHC is self-limited over a period of 5 to 10 days. Because antiviral agents are ineffective, the preferred treatment consists of topical application of cool compresses and astringents. Patients require reassurance, because the appearance of diffuse subconjunctival hemorrhage in the presence of pain and tearing is quite stressful. Patient education should stress the severe communicability of this disorder, and appropriate precautions should be taken to limit the spread of the infection. Topical steroids have not demonstrated any significant effect and may actually prolong the infection. 

Generalized malnntrition may prodnce conjunctival kera-tinization. Vitamin B deficiency can canse abnormal dilatation of the conjnnctival vasculatnre. Vitamin C deficiency can prodnce petechial or spontaneous subconjunctival hemorrhages. Avitaminosis A can cause severe drying of the ocular surfece and the appearance of Bitot s spots on the temporal conjunctiva. 

Once healing has begun, frequent use of nonpreserved artificial tears or lubricating gels often improves patient comfort. No specific therapy is required for conjunctival contusions, because most involve only subconjunctival hemorrhages that are self-limiting. Warm compresses used for 15 to 20 minutes several times daily may hasten resorption of blood. 

Examination typically reveals a marked conjunctivitis with a primarily follicular and papillary response of the palpebral conjunctiva.The follicles typically are worse in the inferior palpebral conjunctiva, with papillae more common in the superior. Preauricular lymphadenopathy is present in about 64% of patients at presentation and lasts approximately 1 week. Small subconjunctival hemorrhages are not an uncommon characteristic. 

Pharyngoconjunctival fever and acute hemorrhagic conjunctivitis are similar to EKC in presentation except for a recent history of upper respiratory problems and fever in pharyngoconjunctival fever and development of large subconjunctival hemorrhages in acute hemorrhagic conjunctivitis. The cornea typically is less involved in each of these conditions, but they are treated in the same manner as EKC. 

The ocular side effects of corticosteroids are many and are related to the route of administration. The most common concerns are increased intraocular pressure (lOP) and cataracts, but delayed epithelial woimd healing and increased risk of infection due to immime modulation and decreased tear lysozyme levels are issues for the cornea. Changes to other ocular tissues have been noted (subconjunctival hemorrhages, blue sclera, eyelid hyperemia and edema, retinal emboUc events, central serous choroidopathy) and neurologic compUcations reported (diplopia, nerve palsies, intracranial hypertension) (see Appendix 35-1). 

Possible" effects (all possibly due to the associated activity and not the drug) mydriasis, retinal vascular accidents, subconjunctival hemorrhages, anterior ischemic optic neuropathy (NAION), central serous chorioretinopathy (CSCR)... 

Delayed corneal epithelial wound healing, PSC, decreased resistance to infection, decreased tear lysozyme, eyelid and conjunctiva hyperemia/edema/angioneurotic edema, subconjunctival hemorrhage, translucent blue sclera, increased lOP, myopia, exophthalmos, intracranial hypertension causing papilledema, diplopia, EOM paresis and eyelid ptosis, retinal hemorrhages (secondary to injection), central serous choroidopathy, abnormal ERGA EP, retinal embolic phenomenon (injection). 

May increase bleeding tendencies (subconjunctival hemorrhage, retinal hemorrhage). 

Possible corneal ulceration, eyelid edema, diplopia, optic neuritis, permanent dry eye, subconjunctival hemorrhage. 

Miosis occurs from direct contact of vapor with the eyes. It may also occur from moderate to severe exposure of skin to liquid agent or from a liquid droplet near the eye. Miosis will begin with seconds or minutes following vapor exposure and may not be complete for many minutes if the exposure concentration is low. In unprotected individuals, miosis is bilateral and is often accompanied by complaints of pain, dim and blurred vision, conjunctival injection, nausea, and occasionally vomiting. On occasion, subconjunctival hemorrhage is also present. 

In patients treated with pegaptanib sodium alone, ocular adverse events considered likely to be associated with intravitreal injection of pegaptanib sodium included vitreous floaters or haze, mild transient anterior chamber inflammation, ocular irritation, increased IOP, intraocular air, subconjunctival hemorrhage, eye pain, lid edema/ erythema, dry eye, and conjunctival injection. In patients treated with pegaptanib sodium and PDT, adverse events probably associated included ptosis (due to the contact lens), mild anterior chamber inflammation, corneal abrasion, eye pain, foreign body sensation, chemosis, subconjunctival hemorrhage, and vitreous prolapse. 

Subtenon High vitreal drug levels, relatively noninvasive, fewer complications unlike intravitreal delivery Retinal pigmented epithelium, chemosis, subconjunctival hemorrhage... 

The risk of subconjunctival hemorrhages in patients taking warfarin has been assessed in a retrospective chart review of 4334 patient visits over 2 years there were 15 events, giving an event rate of 0.35% [101. 

Leiker LL, Mehta BH, Pruchnicki MC, Rodis XL. Risk factors and complications of subconjunctival hemorrhages in patients taking warfarin. Optometry 2009 80(5) 227-31. 

---