A 26-year-old carpenter sustains left eye trauma. The patient’s best-corrected visual acuity is 20/20, and there is intact extraocular movement. A photograph of the eye is shown. What is the most appropriate next step?

• A. Transfer to ED
• B. Apply antibiotic drops and discharge
• C. Do home care
• D. Refer to ophthalmologist in 2 weeks

Answer: (C)

The main idea is that after eye trauma, if vision is normal and there are no signs of a damaged globe, the finding pictured is most consistent with a benign subconjunctival hemorrhage. This occurs when small conjunctival vessels bleed under the white of the eye and looks alarming but typically causes no pain and does not affect vision. Because best-ccorrected visual acuity is 20/20 and eye movements are intact, there is no urgent need for hospital transfer, antibiotics, or immediate specialist care. The appropriate approach is conservative management at home.

Use cold compresses for the first day or two to reduce the bleeding, then warm compresses if you prefer to help the blood reabsorb. You can use over-the-counter lubricating eye drops to ease any irritation, and avoid rubbing the eye. Return for care if you develop new symptoms such as decreasing vision, increasing eye pain, persistent or worsening redness, photophobia, discharge, or if the redness and bleeding do not begin to improve within a week or so. Avoid activities that could re-injure the eye or involve contact sports until the eye has healed.