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Refer for an ophthalmological assessment (or consider Optometrist triage) if the abrasion is not resolving, or if visual acuity deteriorates or pain increases.5Subconjunctival haemorrhageSubconjunctival haemorrhage occurs when blood vessels in the space between the sclera and the conjunctiva rupture. This may be caused by blunt trauma to the eye, coughing, sneezing or straining. In some cases, it may be associated with atherosclerosis, bleeding disorders or hypertension.12 Subconjunctival haemorrhage, while often dramatic in appearance, is usually harmless. It is not associated with any significant pain and does not affect vision – if the patient has significant pain, photophobia and reduced vision, reconsider the diagnosis and refer them for an ophthalmological assessment if uncertain.12In most patients, subconjunctival haemorrhage will resolve without treatment in one to two weeks.12 Use of artificial tears may relieve any discomfort. Check the patient’s blood pressure and, if they are taking warfarin, it is recommended that their INR level is checked.12EpiscleritisEpiscleritis is a local inflammation of the superficial top layer of the sclera.12 Patients present with dilated superficial blood vessels in a localised area of the sclera, as opposed to conjunctivitis which appears more diffuse. Patients usually report mild pain only, discharge and photophobia are usually absent and vision is unaffected.12 Localised tenderness is a helpful diagnostic feature.BPJ Issue 54 19Episcleritis resolves without treatment, within approximately three weeks. Artificial tears may be used to relieve discomfort,12 and an oral non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, used if required. If symptoms worsen, consider the possibility of scleritis.BlepharitisBlepharitis is a chronic inflammation of the margin of the eyelids, which can present in patients as a “red eye”, with burning, pruritis and discharge. It is frequently seen in older people, and people with rosacea and seborrhoeic dermatitis.17 Blepharitis is caused by dysfunctional secretions of the Meibomian glands, oil-secreting glands in the eyelid margin which help the tears to distribute evenly across the ocular surface and decrease tear evaporation.
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