Subconjunctival Hemorrhage with Associated Periorbital Ecchymosis

Case at a Glance

A 31-year-old male presents with unilateral subconjunctival hemorrhage and periorbital ecchymosis of unknown etiology, with a history of substance use that may contribute to hypertensive episodes.

Patient's Story

The patient is a 31-year-old male (height 5'8", weight 230 lbs) who presented with concerns about blood in his eye that appeared approximately one week prior. He reports regular use of kratom and nicotine products, both of which he acknowledges can elevate blood pressure. The patient denies any history of alcohol consumption. He noticed the onset of significant redness in one eye accompanied by bruising around the eye area, with no recollection of physical trauma to the region.

Initial Assessment

Upon initial observation, the patient exhibited a prominent subconjunctival hemorrhage with associated periorbital ecchymosis (black eye) in the absence of reported trauma. The patient attributed these findings to a possible acute hypertensive episode related to his substance use patterns. Visual acuity and eye movement appeared unaffected based on patient report.

The Diagnostic Journey

The patient monitored the condition over the course of one week, noting that while the periorbital bruising resolved, the subconjunctival hemorrhage migrated from the initial corner location to spread around the limbus area. The patient became concerned about the persistence and migration pattern of the hemorrhage and sought medical guidance regarding the need for professional evaluation.

Final Diagnosis

Subconjunctival hemorrhage with resolved periorbital ecchymosis, likely secondary to acute blood pressure elevation. Differential considerations include spontaneous vascular rupture versus unrecognized minor trauma.

Treatment Plan

Conservative management with close monitoring recommended. Blood pressure evaluation and substance use counseling advised. Ophthalmologic consultation indicated if symptoms persist, worsen, or if visual changes occur.

Outcome and Follow-up

Patient advised to seek immediate ophthalmologic evaluation for proper assessment of intraocular pressure, complete eye examination, and to rule out more serious underlying pathology. Blood pressure monitoring and lifestyle modification counseling regarding substance use recommended for long-term management.