Letter to Editor
Bilateral Subconjunctival Hemorrhage and Periorbital Petechiae due to Chronic Cough in a Child

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*Mandeep Tomar, *Gaurav Sharma, #Tarun Sood
*Department Of Ophthalmology Dr. Rajendra Prasad Government Medical College Tanda Kangra H.P., India
#Civil Hospital Sarkaghat District Mandi,H.P., India

Corresponding Author
: Mandeep Tomar
Senior Resident, Department of Ophthalmology,
Dr. Rajendra Prasad Government Medical College Tanda
Kangra H.P., India
E-mail: sunnyigmc85@gmail.com


Subconjunctival hemorrhage though a benign condition is quite alarming for the patient. The major risk factors include trauma and contact lens usage in young age group, whereas hypertension, diabetes, and arteriosclerosis among the elderly.
A 5 year old girl child presented with acute bilateral subconjunctival hemorrhage and eyelid ecchymosis for the last 5-7 days. Rest of the ocular examination was normal. She gave history of severe cough with mild fever since 7 days. Blood investigations revealed a normal coagulation profile, haemogram and platelet count with an ESR of 37 mm. Pediatric consultation was sought and she was diagnosed as a case of acute upper respiratory tract infection. She was prescribed syrup azithromycin and antitussives and the child recovered completely within 2 weeks.
The common causes of subconjunctival hemorrhage are local trauma, systemic hypertension, acute conjunctivitis and diabetes mellitus.[1] Other causes include conjunctival tumors, conjunctivochalasis, ocular amyloidosis and contact lens usage. Subconjunctival hemorrhage may also occur after sudden severe venous congestion following Valsalva maneuver, whooping cough, vomiting, sneezing, weight lifting, crush injury, or spontaneously.[2] In our patient an initial diagnosis of viral keratoconjuctivitis had been made and the treatment got delayed. The chronic cough lead to repeated haemorrhages and worsening of symptoms. Thus a thorough systemic history and clinical examination is required in such cases.


1.    Fukuyama J, Hayasaka S, Yamada K, Setogawa T. Causes of subconjunctival hemorrhage. Ophthalmologica 1990200:63–7.
2.    Duke-Elder S. System of Ophthalmology Diseases of the Outer Eye. VIII. London: Henry Kimpton; 1965. Conjunctival diseases; pp. 34–39.