Hemorrhagic chemosis
Background
- Not to be confused with standard subconjunctival hemorrhage
- Sometimes referred to as subconjunctival hematoma or bloody chemosis
- Results from the rupture of subconjunctival blood vessels, typically due to significant trauma
Clinical Features
- Normally associated with significant ocular trauma.
- Painful (at rest or with eye movements)
- May have change in visual acuity
- Examination
- Fresh raised hemorrhagic chemosis
Differential Diagnosis
The following are conditions that may appear similarly to hemorrhagic chemosis but have an alternate etiology:
- Carotid-cavernous fistula
- Cavernous venous thrombosis (can present with chemosis + proptosis)
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
Workup
- Check visual acuity
- Visualize injury with slit lamp exam
- Consult ophthalmology if available or consider transfer if not
- Obtain orbital CT imaging
- Once globe rupture is ruled out, continue with tonometry and fluoroscein exam.
- Consider
- Coagulation studies
- Vessel imaging of the head if suspicion for CVT
Diagnosis
While most cases of hemorrhagic chemosis occur following trauma, it is important to also consider whether the patient has an underlying coagulopathy or structural condition (ie. cavernous venous thrombosis) that would predispose them to this or a similarly appearing condition[1]. When assessing a patient with hemorrhagic chemosis, the following associated conditions should be considered:
- Globe rupture
- Scleral laceration
- Penetrating foreign body
Management
If globe rupture is suspected:
- Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency
- Initiate broad spectrum antibiotics
- Check tenatus vaccine status and administer if due
- Consider placement eye shield as protective measure to avoid further damage
Disposition
- Ultimate disposition often depends on the associated ocular trauma for which hemorrhagic chemosis may be a sign.
See Also
External Links
References
- ↑ Pargament J, Corrêa ZM, Augsburger JJ. Ophthalmic trauma. In: Riordan-Eva P, Augsburger JJ, eds. Vaughan and Asbury’s General Ophthalmology. 19 ed. New York, NY: McGraw-Hill; 2018:380-389.