PANCE Blueprint EENT (7%)

Patient will present as → a 45-year-old individual who noticed a bright red patch on the white of one eye upon waking up this morning. The patient reports no pain, vision changes, or recent injury to the eye but feels self-conscious about the appearance. The red patch does not extend to the iris, and there is no discharge or photophobia. The patient has no significant PMHx and is on no medications. On examination, visual acuity is 20/20 in both eyes. Intraocular pressure is within normal limits. Anterior segment examination of the right eye reveals a well-demarcated, bright red area on the nasal conjunctiva. Blood pressure is 120/80, and the left eye examination is unremarkable. Fundoscopic examination of both eyes is normal. The patient is diagnosed with a subconjunctival hemorrhage. They are advised to avoid eye rubbing and use artificial tears for irritation. They are instructed to return if there is no resolution within 2 weeks or if there are recurrent episodes.

Subconjunctival hemorrhage is a benign condition characterized by a sudden onset of a unilateral bright red patch on the sclera due to the rupture of small blood vessels under the conjunctiva

• It can occur spontaneously or be triggered by coughing, sneezing, heavy lifting, vomiting, or even rubbing the eye too hard
• While it may look alarming, it typically causes no pain, no vision changes, and no discharge
• Risk factors include hypertension, diabetes, blood thinning medications, and certain blood clotting disorders

Subconjunctival hemorrhage eye. Broken blood vessel.

Diagnosis is primarily clinical, based on the characteristic appearance of a bright red or dark red patch on the sclera, with clear demarcation, and absence of other symptoms such as pain, vision loss, or discharge

• No specific tests are usually required unless recurrent hemorrhages suggest an underlying systemic condition

Treatment is generally not required as the condition resolves on its own within two weeks. Artificial tears can help with any mild irritation

• Patients should be reassured about the benign nature of the condition
• Advise avoiding rubbing the eye and monitoring for recurrent episodes, which may warrant further investigation for underlying systemic conditions
• Check blood pressure
• If the patient is on anticoagulant therapy, consider reviewing the medication, especially if hemorrhages are recurrent