Question

*image of subconjunctival hemorrhage* A 55-year-old woman with a history of chronic bronchitis presents and is concerned about the appearance of her left eye. She denied a change in vision or any discomfort but is concerned because she noticed "blood in my eye" this morning. Evaluation of the patient demonstrates intact extraoccular muscles; pupils that are equal, round, and reactive to light; and visual acuity of 20/30 in each eye. Which of the following is the most appropriate next step in the evaluation and management of her complaint?

A CT scan of the orbit and facial bones to evaluate for globe injury
B Measure intraocular pressure to rule out a retrobulbar hematoma
C Obtain an ophthalmology consultation
D Reassure the patient and discharge her home
E Stain with fluorescein dye and assess for a corneal abrasion

Answer 1

Reassure the patient with the subconjunctival hemorrhage and discharge her home, as no symptoms suggest immediate concern or need for the additional evaluations listed.

Step-by-step explanation:

The best next step in the evaluation and management of the patient's complaint, given the image of a subconjunctival hemorrhage and the absence of vision changes or discomfort, is to reassure the patient and discharge her home. This condition is typically benign and resolves on its own without the need for further intervention unless symptoms like vision changes or pain occur. The other options presented are unnecessary given the patient's clinical presentation: A CT scan is not indicated without signs of globe injury; measuring intraocular pressure is more relevant for glaucoma screening and not directly related to subconjunctival hemorrhage; an ophthalmology consultation is not necessary at this stage; and staining with fluorescein is used for detecting corneal abrasions, which the patient does not exhibit signs of having.