A 15-year-old high school student presents to the emergency department with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis?

Since the patient denies having any type of trauma or injury to the eye a corneal abrasion can be ruled out. The patient is not having any visual disturbances, pain, or discharge that can rule out conjunctivitis, and acute iritis. This leaves the doctor with the conclusion it is a subconjunctival hemorrhage.

A subconjunctival hemorrhage is caused when the small blood vessels in the eye break. This can be caused by forceful coughing. Since the patient has stated he has been coughing and has had a cold this will be the reason for the broken blood vessels in the eye. The red spot in the left eye is actually bleeding that is showing. It is harmless and will heal on its own after a few days.

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