Dilate or not in subconjunctival haemorrhage?
Reviewed by Eulee Seow

There is often surprisingly little evidence in common clinical conditions. Spontaneous non-traumatic subconjunctival haemorrhage (SCH) is frequently encountered in emergency and walk-in clinic visits. In some centres, a dilated fundus exam is performed to exclude retinal pathology. This retrospective study investigated the yield of a dilated fundus exam in spontaneous non-traumatic SCH and associated risk factors. Of 3900 consecutive patients seen in a four month period 107 (2.7%) were diagnosed with a spontaneous non-traumatic SCH. A total of 2219 patients concurrently diagnosed with other ophthalmic conditions were utilised as age- and gender-matched controls. History of hypertension, warfarin, acetylsalicylic acid (ASA) or non-steroidal anti-inflammatory drug (NSAID) and antihistamine use were recorded by history taking. All patients received a complete ophthalmic exam by a trained ophthalmologist. All presentations of SCH were unilateral and dilated fundus exams failed to show any retinal pathology. There was a significant difference in warfarin and ASA/NSAID use in patients with spontaneous SCH compared to the control group which is to be expected given the mechanisms of these medications. There was also a statistically significant difference in antihistamine use, which may be due to increased frequency of rubbing and associated microtrauma. This will hopefully reassure and confirm current advice given to patients with spontaneous subconjunctival haemorrhage. 

Dilated fundus exam and associated findings in spontaneous subconjunctival haemorrhage.
Huynh N, Wang J, Vavvas D.
ACTA OPHTHALMOLOGICA
2017;95:e432-3.