bad subconjunctival hemorrhage

[Mr WZ Boson]

Hello,

Yesterday I woke up with a bad subconjunctival hemorrhage - it looked so scary that I went to the hospital to get advice. I was told that it was harmless and would clear up in a few weeks.

I'm a bit worried that it's such a bad case this clearup won't happen and I'll be left with a permanently red eye.

To give you an idea - it's worse than the pic shown on ...

http://mdchoice.com/pt/Photo/img/img0085.jpg

... the blood covers 100% of the white and there's quite an extensive raised area (presumably a 'bag of blood') which means I get discomfort when I blink.

I've had the occasional minor eye-bleed (frequency twice a year) in the past, but these have cleared up in a couple of days - this is a major blow-out in comparison.

I travelled by air the day before it happened and I wonder if this could have been a factor?

I also wonder if anyone has seen a really bad hemorrhage and how long it could take to recover?

Many thanks for any advice, comments or thoughts.

Mr WZ Boson

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[Kalel]

One of my classmates had a subconjunctival hemmorrhage just as bad as yours was. It takes a few weeks to months for the blood to go away. In the mean time, it's gross!

 

[Redhawk]

Have you ever been evaluated for a clotting disorder? I don't know if that's necessary, but you say you've had these occur (albeit less severe) multiple times per year?

I don't think the "bag of blood" that you're describing implies a worse prognosis, assuming a complete exam was done and this was the only abnormality noted. It appears that you have no history of globe trauma. I'm sure someone with much more training will chime in on this, though.

 

[Kalel]

Whoops, missed that "several times a year" line. Anyways, I'd talk with your primary care doctor about this. He or she should send you to an ophthalmologist, but he or she should also probably initiate a work-up that should include things like a CBC, Coags, and Protein C/S level. I might start a broader w/u if you had other symptoms. Anyways, here's a helpful website:

http://www.emedicinehealth.com/articles/14658-2.asp

 

[Andrew_Doan]

I travelled by air the day before it happened and I wonder if this could have been a factor?

In addition to the above comments, patients with recurring subconj. heme. may have underlying high blood pressure:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1390514

Although I couldn't find any papers on flying and subconj. heme., scuba divers also develop this problem due to pressure changes. It's hypothesized that change in cabin pressure during flying can also cause subconj. heme. We know that hanging people upside down can induce this problem:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3974054

This is usually benign, but it's a good idea to check a cbc with diff, coagulation, and blood pressure when subconj. heme. occurs often.

An optometrist told his patient to see the "on call doctor" (me) and get an urgent MRI for a subconj. heme. that also occurred after flying. It took me about one hour to convince the patient that she did not need an MRI.

 

[Mr WZ Boson]

Thanks for the feedback.

They did a clotting test and it was OK & my blood pressure measures OK.

So I guess I'll just have to put it down to "life's rich tapestry".

Mr WZ Boson

 

[marley]

of course an optometrist recommended an mri.....I could come up with plenty of cases were md's have made inappropriate recommendations or handled a case the wrong way....will this name calling and finger pointing ever stop...if you ask me it is a bit childish....I think the whole md..od thing isn't about patient care, it is about money and turf.....hmmm I just spoke with my brother about a general practitioner md who was treating an acute angle closure with polytrim for 2 weeks.....too bad the patient lost >50% of her visual field in the meantime before my brother, an od, successfully treated her real problem...look you guys need to realize that we aren't trying to take over your profession and do "surgery"....but pointing a laser at the post. capsule and clicking a button is not surgery...neither is removing a chalazion, punctal plugs, ALT, epilation, or even lasik...(my god, the procedure is simple, and the complications are easy to manage 99% of the time)...I've worked as an RN for years we do plenty of procedures that are more invasive than the above....and RN's only went to school for 2-4 yrs.....not 8....quit trying to rule the eye care industry and face the facts that our healthcare system in America is changing....get off your high horse!...if you ask me you guys are loosing face in the eye of the public by making these ridiculous accusations...and eventually our justice system will prove you wrong..again!...just like they did when you tried to prevent us from treating conjunctivitis.....the majority of the people in America have primary care needs,....my god we can help these people, stop trying to make primary care things seem so difficult and like rocket science!...our health care system is more efficient if we have more gatekeepers in the primary care realm...

 

[Andrew_Doan]

look you guys need to realize that we aren't trying to take over your profession and do "surgery"....but pointing a laser at the post. capsule and clicking a button is not surgery...neither is removing a chalazion, punctal plugs, ALT, epilation, or even lasik...(my god, the procedure is simple, and the complications are easy to manage 99% of the time)...I've worked as an RN for years we do plenty of procedures that are more invasive than the above....and RN's only went to school for 2-4 yrs.....not 8....quit trying to rule the eye care industry and face the facts that our healthcare system in America is changing....get off your high horse!..

You need to sit back. Take a deep breath. Read the OK Optometric bill. We're talking about more than epilations and punctal plugs. In fact, no one is trying to take these non-surgical procedures away from optometry. OK optometrists now have the "legal backing" to perform ALL non-laser surgeries. There is no need for further expansion of the optometric scope of practice.

Name calling? Read this:
"The Association also launched an aggressive advertising campaign and television commercials will run throughout May highlighting three B.C. patients who had serious diseases and health conditions discovered through a comprehensive eye exam by an optometrist:

* David Klein, 22, of Coquitlam, had a brain tumour detected.
* Kyoko Hayashi, 27, of Richmond , had a retinal detachment (if undetected leads to blindness).
* Brenda Holroyd, 45, of North Vancouver , had high blood pressure and glaucoma detected."

This is the lobbying effort of Canadian optometrists to prevent optician refractions.

Interesting eh? It requires public awareness to change things, and optometry, as well as, ophthalmology knows this. Perhaps we should discover how many times these "misdiagnoses" occur in optometric vs ophthalmology practices. For the most part, optometry has done a good job covering their backs by claiming, "but I sent the patient to a specialist..." Inevitably, the ophthalmologist takes care of the problem and never reports because the reports sit on a desk at the AOA or they are afraid their referals will dry up. I understand that mistakes will happen. We're all human. However, mistakes tend to happen more frequently when there are non-physicians with less training making crucial decisions. A little knowledge is a dangerous thing. This issue is about maintaining a standard level of care for patients.

As for your brother, good for him. May I ask what state he's from? The treatment for acute angle closure glaucoma may require both aggressive medical and surgical treatments. It's also interesting that an acute angle closure patient is "walking around" for two weeks. Usually these patients are vomiting with severe headaches. Thus, this is atypical for a patient with an acute angle closure episode to be walking around for two weeks.

I was speaking with a friend from India at lunch about optometric surgery. Although India is a country with about one million new cataracts per year, optometry is banned from doing intraocular surgery. It's not about money in India. The Indian government has recognized that allowing non-surgeons to perform surgery is a risk to public health.

 

[marley]

excuse me...you need to sit back, take a breath....and read this

"Ostensibly, HR 3473 was introduced in the House of Representatives in response to pressure from the American College of Surgeons, American Medical Association and American Academy of Ophthalmology. These groups want to curtail VA optometrists from performing some laser surgical procedures. But the wording of this bill now goes further than that. HR 3473 would also prohibit VA optometrists from performing such minor surgical procedures as punctal dilation, epilation of lashes, insertion of punctal plugs and other procedures commonly performed by optometrists.".....

....not to mention the AAO has decided we aren't good enough to attend their meetings...again childish!.....I agree optometrist have no business in the operating room of a real "surgery"....the difference between the Canadian Optometrist and the AAO is the Canadians have a valid point as illustrated in the above post....you on the other hand don't......we absolutley don't have any business doing real surgeries....but the procedures mentioned above are in jeopardy at this point....your point about optometrist covering their back's is weak....this is what we do, we screen for major diseases or vision threatening problems and we either treat if the laws allow us, or make the appropriate referral....mistakes are made on both sides (md and od)....and I bet there are omd's out there who consult with other omd's about difficult cases..

"However, mistakes tend to happen more frequently when there are non-physicians with less training making crucial decisions."....

....I agree that is why our program trains us to be primary eye care physicians!.....obviously a little knowledge is a dangerous thing! (thanks for telling me something I already know)...nobody wants to change the standard of care for patients.....do you really think we are going to try and do the wrong thing for the patient in this day and age....my god the court system would eat us alive.....if anything od's are more careful with difficult cases...

you don't have to tell me my brother did a good job with the acute angle case,....I know he did....and I also know this case was atypical.....I can read your sarcasm......her pressure was brought under control with in-office techniques (meds and digital massage)....and bilateral PI's were done that day...


about your comments on your friend from India.....guess what...this isn't India....this is america...the laws are different and the training for an optometrist is different.....do you think surgeons in china are the same as in america.......no

 

[Andrew_Doan]

I'm in full support of the VA bill. I agree that the wording may be misinterpreted as including punctal plugs and epilation. This will and can be fixed as congress considers this bill. However, these procedures are not considered to be "puncturing tissue" nor does it "cut". Optometrists (OD) will still be able to do many of the procedures already allowed in all 50 states. What this bill does is to prevent laser surgery (although you down play lasers as a surgical instrument). Optometric laser surgery is already illegal in 49 out of 50 states. The fact is that the VETS bill does nothing to affect state laws and current optometric scope of practice. The goal of the VETS bill is to prevent Oklahoma optometrists from performing laser and non-laser surgery in the VA. If you do the math, then this VETS bill will affect less than 0.1% of all optometrists.

So what is all this fuss about?

Organized optometry in Oklahoma, which you conveniently ignore each time you post, has lobbied successfully for surgical privileges. These optometrists have used their attendance at meetings like the AAO Academy meeting to support credentialing.

nobody wants to change the standard of care for patients.....do you really think we are going to try and do the wrong thing for the patient in this day and age....my god the court system would eat us alive.....

Nobody is a strong word. Look in Oklahoma.

my god the court system would eat us alive.....

In regards to the court system, I'm counting on this if optometrists are granted surgical privileges.

....I agree that is why our program trains us to be primary eye care physicians!.....obviously a little knowledge is a dangerous thing! (thanks for telling me something I already know)

We will never change each other's minds. In particular, if you insist that optometrists are physicians, then we will never see eye to eye.

 

[marley]

phy?si?cian ( P ) Pronunciation Key (f-zshn)
n.
A person licensed to practice medicine; a medical doctor.
A person who practices general medicine as distinct from surgery.
A person who heals or exerts a healing influence.


physician

1. A person skilled in physic, or the art of healing; one duty authorized to prescribe remedies for, and treat, diseases; a doctor of medicine.


Source: Webster's Revised Unabridged Dictionary, ? 1996, 1998 MICRA, Inc.


physician

n : a licensed medical practitioner; "I felt so bad I went to see my doctor" [syn: doctor, doc, MD, Dr., medico]


Source: WordNet ? 1.6, ? 1997 Princeton University

...........do you refuse to acknowledge the English language?.....I think we meet the definitions above......you should really check you ego.....are you afraid someone won't realize that you are superior to all other eye health care providers?.....again, get off your high horse!!

 

[Mirror Form]

phy?si?cian ( P ) Pronunciation Key (f-zshn)
n.
A person licensed to practice medicine; a medical doctor.
A person who practices general medicine as distinct from surgery.
A person who heals or exerts a healing influence.


physician

1. A person skilled in physic, or the art of healing; one duty authorized to prescribe remedies for, and treat, diseases; a doctor of medicine.


Source: Webster's Revised Unabridged Dictionary, ? 1996, 1998 MICRA, Inc.


physician

n : a licensed medical practitioner; "I felt so bad I went to see my doctor" [syn: doctor, doc, MD, Dr., medico]


Source: WordNet ? 1.6, ? 1997 Princeton University

...........do you refuse to acknowledge the English language?.....I think we meet the definitions above......you should really check you ego.....are you afraid someone won't realize that you are superior to all other eye health care providers?.....again, get off your high horse!!

Hmm, most of the definitions seem to be that of a doctor of medicine, not optometry. If you want to include anybody who happens to heal, then I guess opticians, med techs, nurses, and pretty much everybody else in anyway associated with the health care would be labeled "physicians."

But we could argue about semantics all day. It won't change the fact that currently when the the word physician is used, it's generally referring to only medical doctors.

 

[Andrew_Doan]

This is childish, but I'll use the same argument against optometrists:

Definition of Optometrist
Op`tom?e`trist

n. 1. One who is skilled in or practices optometry, especially one who examines the eyes for defects in vision and prescribes the proper lenses to correct any defects discovered.


Related Words
oculist, specialiser, specialist, specializer

Source: Webster Dictionary

 

[maxwellfish]

Optometrist

"Optometrists, also known as doctors of optometry, or ODs, provide most primary vision care. They examine people?s eyes to diagnose vision problems and eye diseases, and they test patients? visual acuity, depth and color perception, and ability to focus and coordinate the eyes. Optometrists prescribe eyeglasses and contact lenses and provide vision therapy and low-vision rehabilitation. Optometrists analyze test results and develop a treatment plan. They administer drugs to patients to aid in the diagnosis of vision problems and prescribe drugs to treat some eye diseases. Optometrists often provide preoperative and postoperative care to cataract patients, as well as patients who have had laser vision correction or other eye surgery. They also diagnose conditions due to systemic diseases such as diabetes and high blood pressure, referring patients to other health practitioners as needed."

www.bls.gov

 

[maxwellfish]

More then lenses, Dr. Doan... more than lenses.

 

[Andrew_Doan]

"They also diagnose conditions due to systemic diseases such as diabetes and high blood pressure, referring patients to other health practitioners as needed."

I never claimed optometry only prescribed glasses and contact lenses. You're disregarding the fact that I'm arguing against optometrists managing serious systemic diseases or performing surgery, laser and non-laser surgeries.

From the BLS definition, optometry is more than glasses. I agree with this. I think optometry functions well as primary eye care providers. However, it appears that BLS also agrees with me that optometry refers patients to "other health practitioners as needed." This is far from being a "physician" as some optometrists would like to claim! Also, many optometrists think they are equivalent to general ophthalmologists.

 

[maxwellfish]

I just think it is funny how some cling so tightly to titles like "doctor" and "physician"... To each his own I guess. As far as doctor goes, I just wonder what ya'll called your profs in college.

I like that you agree that optometrists are primary care, and handle certain diseases. I think the ophthalmology community would do better to strenghthen that idea, as well as, entertain the idea of co-management, and maybe optometry will stop fighting for the extreme.

The "Os" can all enjoy a piece of the pie.

 

[Mirror Form]

I just think it is funny how some cling so tightly to titles like "doctor" and "physician"...

If you worked as hard as we do to earn those titles, you'd understand why. You'd also understand why we don't like people who put in less then one third of the dues trying to get the same reward. But it's definitely not just about doctor's jobs. Havine non-physicians licensing serious surgeries is a pretty radical development that most physicians obviously see as being bad for patient care, and hence logically have some animosity toward those pushing for it.

 

[maxwellfish]

very ignorant of you to consider only doctors of medicine "doctors"... when it refers to the degree of doctorate.

remember not all ODs want surgical rights... they just want to do what they are trained for, not mere refraction.

 

[Andrew_Doan]

very ignorant of you to consider only doctors of medicine "doctors"... when it refers to the degree of doctorate.

remember not all ODs want surgical rights... they just want to do what they are trained for, not mere refraction.

You're confusing doctor with physician. Doctor applies to PhD, OD, DDS, MD, JD, etc...

Physician is typically used for a medical doctor (MD or DO). Optometrists are not physicians.

 

[maxwellfish]

no I am not confusing them... sledge seemed to lump them together