Hemorrhagic chemosis - Revision history

Rossdonaldson1: /* Clinical Features */

2023-03-01T23:07:15Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
			[[File:PMC4005189 MEAJO-21-196-g002.png\|thumb\|Marked lid edema and subconjunctival hemorrhagic chemosis, with "black ball [[hyphema]]" in the right eye after direct trauma.]]
	*Normally associated with significant ocular trauma.		*Normally associated with significant ocular trauma.
	*Painful (at rest or with eye movements)		*Painful (at rest or with eye movements)

2023-03-01T22:50:51Z

Evaluation

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	==Evaluation==		==Evaluation==
	~~1. Check visual acuity<br>~~
	~~2. Visualize injury with slit lamp exam<br>~~
	~~3. Consult ophthalmology if available or consider transfer if not<br>~~
	~~4. Obtain orbital CT imaging<br>~~

	~~Once globe rupture is ruled out, continue with tonometry and fluoroscein exam.~~


	===Workup===		===Workup===
	*Coagulation studies		*Check visual acuity
	*Vessel imaging of the head if suspicion for CVT		*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===		===Diagnosis===

2023-03-01T22:47:46Z

Background

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	*Not to be confused with standard [[subconjunctival hemorrhage]]		*Not to be confused with standard [[subconjunctival hemorrhage]]
	*Sometimes referred to as subconjunctival hematoma or bloody chemosis		*Sometimes referred to as subconjunctival hematoma or bloody chemosis
	*Results from the ~~significant~~ rupture of subconjunctival blood vessels.		*Results from the rupture of subconjunctival blood vessels, typically due to significant trauma

	==Clinical Features==		==Clinical Features==

2023-03-01T22:47:22Z

Background

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	==Background==		==Background==
	~~Hemorrhagic chemosis, sometimes~~ referred to as subconjunctival hematoma or bloody chemosis~~, is a finding of raised [[subconjunctival hemorrhage]] resulting~~ from the rupture of subconjunctival blood vessels.		*Not to be confused with standard [[subconjunctival hemorrhage]]
			*Sometimes referred to as subconjunctival hematoma or bloody chemosis
			*Results from the significant rupture of subconjunctival blood vessels.

	==Clinical Features==		==Clinical Features==

2023-03-01T22:46:08Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	~~Often the patient's history will involve~~ significant ocular trauma. ~~Depending on the mechanism, other features may include~~ change in visual acuity~~, painful eye or pain with eye movements,~~		*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==		==Differential Diagnosis==

2023-03-01T22:42:13Z

Disposition

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	==Disposition==		==Disposition==
	Ultimate disposition often depends on the associated ocular trauma for which hemorrhagic chemosis may be a sign.		*Ultimate disposition often depends on the associated ocular trauma for which hemorrhagic chemosis may be a sign.

	==See Also==		==See Also==

2023-03-01T22:42:03Z

Management

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	If [[globe rupture]] is suspected:		If [[globe rupture]] is suspected:
	*Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency		*Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency
	*Initiate broad spectrum antibiotics		*Initiate broad spectrum [[antibiotics]]
	*Check [[tenatus vaccine]] status and administer if due		*Check [[tenatus vaccine]] status and administer if due
	*Consider placement eye shield as protective measure to avoid further damage		*Consider placement eye shield as protective measure to avoid further damage

2023-03-01T22:41:10Z

Management

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	==Management==		==Management==
	If globe rupture is suspected:		If [[globe rupture]] is suspected:
	*Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency		*Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency
	*Initiate broad spectrum antibiotics		*Initiate broad spectrum antibiotics
	*Check tenatus vaccine status and administer if due		*Check [[tenatus vaccine]] status and administer if due
	*Consider placement eye shield as protective measure to avoid further damage		*Consider placement eye shield as protective measure to avoid further damage

2023-03-01T22:40:47Z

Evaluation

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	===Diagnosis===		===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<ref>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.</ref>.
			When assessing a patient with hemorrhagic chemosis, the following associated conditions should be considered:
			*Globe rupture
			*Scleral laceration
			*Penetrating foreign body

	==Management==		==Management==

2023-03-01T22:40:31Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential 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<ref>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.</ref>.
	~~When assessing a patient with hemorrhagic chemosis, the following associated conditions should be considered:~~
	*Globe rupture
	*Scleral laceration
	*Penetrating foreign body
	~~<br>~~

	The following are conditions that may appear similarly to hemorrhagic chemosis but have an alternate etiology:		The following are conditions that may appear similarly to hemorrhagic chemosis but have an alternate etiology:
	*Carotid-cavernous fistula		*Carotid-cavernous fistula
	*Cavernous venous thrombosis (can present with chemosis + proptosis)		*Cavernous venous thrombosis (can present with chemosis + proptosis)

			{{Unilateral red eye DDX}}

	==Evaluation==		==Evaluation==