Association of nocturnal subconjunctival hemorrhage and non-dipper blood pressure pattern: A benign clue for serious diseases

Purpose To evaluate the association between non-dipper blood pressure pattern and subconjunctival hemorrhage (SCH). Methods Twenty-seven consecutive patients with nocturnal SCH and 27 age, sex-matched controls were enrolled. Demographic, blood parameters, office blood pressure measurements, 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Results Mean diastolic blood pressure (DBP) for nighttime (65.03 ± 7.1 vs. 70.78 ± 10.5, p: 0.22), mean heart rate for nighttime (64.54 ± 8.26 vs. 69.93 ± 9.85, p: 0.034), Minimum Systolic Blood pressure(SBP) and DBP values for nighttime (92.44 ± 9.72 vs. 99.44 ± 10.66, p:0.015 and 51.15 ± 8.31 vs. 57.7 ± 11.2, p: 0.018) were higher, nocturnal fall ratio of SBP and DBP were significantly lower in the SCH ( + ) group compared to SCH (-) group (5.38 ± 8.39 vs. 10.34 ± 6.08, p: 0.016 and 4.26 ± 8.92 vs. 13.78 ± 6.97, p < 0001 respectively). Ten patients (37%) in the SCH (-) group and 18 patients (66.7%) in the SCH ( + ) group were non-dippers (p: 0.029). Mean daytime SBP and DBP were higher compared to office measurements of 4 patients (14.8%) in the SCH (-) group and 11 patients (40.7%) in the SCH ( + ) group (p: 0.033) Conclusion SCH had a strong association with non-dipper blood pressure pattern, higher nocturnal heart rate and masked hypertension which are precursors of myocardial infarction, stroke and renal failure. So, SCH should be considered as a clue for serious diseases such as coronary artery disease, myocardial infarction, stroke and patients should be evaluated for ABPM.

Association Between Subconjunctival Hemorrhage and Acute Coronary Syndrome: A 14-Year Nationwide Population-Based Cohort Study

Purpose: Subconjunctival hemorrhage (SCH) is usually a benign ocular disorder that causes painless, redness under the conjunctiva. However, since SCH and acute coronary syndrome (ACS) share many vascular risk factors, studies have suggested that these two disorders may be significantly associated with each other, and evaluate the concomitance of ACS in patients with SCH.Methods: This population-based cohort study, enrolled 35,260 Taiwanese patients, and used the Taiwan National Health Insurance Research Database to identify patients with ACS and SCH. Outcomes were compared between the with and without SCH groups. The study population was followed until the date of ACS onset, the date of withdrawal, death, or December 31st 2013, whichever came first.Results: Of the 85,925 patients identified with SCH between 1996 and 2013, 68,295 were excluded based on the study's exclusion criteria, and a total of 17,630 patients with SCH who were diagnosed by ophthalmologists between 2000 and 2012 were eligible for analysis. After 1:1 propensity score matching for 5-year age groups, gender, and the index year, the results showed that SCH was more common in the 40–59 age group (53.82%) and females (58.66%). As for the ACS-related risk factors, patients with diabetes mellitus (aHR = 1.58, 95% CI = [1.38, 1.81]), hypertension (aHR = 1.71, 95% CI = [1.49, 1.96]) and patients taking aspirin (aHR = 1.67, 95% CI = [1.47, 1.90]) had a notably higher risk of ACS. However, it was found that there were no significant differences in the occurrence of ACS between the non-SCH and SCH patients.Conclusion: This results of this study regarding the risk factors and epidemiology of SCH and ACS were in keeping with previously reported findings. However, the results revealed no significant association between SCH and ACS.

A Clinical comparative study of Vasadi ghrita aschyotana with Carboxymethyl cellulose eye drops in the management of Arjuna w.s.r Subconjunctival hemorrhage

Eyes are the most precious gift of the god to the living beings. Good vision is crucial for social and intellectual development of person. So to protect this organ is not only a necessity but also a responsibility of every individual. India is having the highest rate of head injury in RTA in the world. Out of which 60% suffer from Subconjunctival hemorrhage. Subconjunctival hemorrhage or Ecchymosis is of very common occurrence. Subconjunctival hemorrhage” is a common benign condition of the eye that has characteristic features, such as the painless acute appearance of a sharply circumscribed redness of bleeding underneath the conjunctiva in the absence of discharge, and inflammation in contagious areas. While searching solution for Subconjunctival hemorrhage in ayurveda, its signs and symptoms match very much with Arjuna” described in “Shuklagata roga”. Which is having symptom painless red spot over white surface of eye. So taking these things into consideration “Vasadi Ghrita Aschyotana” was selected for treating the disease Arjuna. The ghrita contain “Vasa” and “Yashtimadhu” having pittashamaka, Shonitasthapan properties.

The Effect of Brimonidine 0.15% on the Development of Bulbar Redness Following Femtosecond Laser Assisted Cataract Surgery

Purpose: To assess the effect of brimonidine tartrate 0.15% on reducing subconjunctival hemorrhage, measured with a bulbar redness score, following femtosecond laser assisted cataract surgery (FLACS). Patients and Methods: A prospective, masked randomized controlled study was done using single-blinded simple randomization. All FLACS cases completed between June and August 2019 were included except those on anticoagulation or with prior conjunctival surgery. All operated eyes received usual preoperative eye drops, while Study group received added brimonidine. Exclusion criteria included >1 vacuum attempt during FLACS and any intraoperative complications. All subjects received Bulbar Redness (BR) Score and Analyzed Area (AA) imaging by Oculus 5M Keratograph preoperatively and postoperatively. AA including non-conjunctival structures, <25mm2, or postoperative AA values >10% different from preoperative values were excluded from final analysis. Absolute values and differences between mean postoperative and preoperative BR and AA were compared using Student’s t-test. Results: 62 eyes (Study group=25, Control group=37) of 56 patients were randomized and included for analysis. Baseline demographic comparison between the two groups were similar. Preoperative BR score in the Study group trended higher (1.62) than Control (1.40, p=0.07), while postoperative BR score remained similar between groups (p=0.70). Difference in postoperative and preoperative BR score was significantly larger in the study group (-0.21±0.56) than controls (+0.06±0.43, p=0.036). Conclusions: The use of preoperative brimonidine in FLACS reduces the amount of postoperative subconjunctival hemorrhage following FLACS, as observed by reduced bulbar redness. Oculus 5M BR scoring has potential to be used as an objective method of quantifying subconjunctival hemorrhage after ophthalmic surgeries and procedures.

Subconjunctival Hemorrhage in a Child with the Blue Rubber Bleb Nevus Syndrome on Treatment with Oral Propranolol

Blue rubber bleb nevus syndrome (BRBNS) is a rare syndrome characterized by venous malformations of mostly skin and gastrointestinal tract. Patients present with multiple venous malformations in various organs including liver, spleen, heart, eye, and central nervous system. Few ophthalmological cases have been published in literature and at present, there are no clear guidelines on the treatment of eye hemorrhages associated with the BRBNS. We report a 3-year-old boy with the BRBNS who developed a spontaneous progressive enlarging subconjunctival hemorrhage in the left eye despite being treated with oral propranolol. The subconjunctival hemorrhage was caused by an underlying conjunctival vascular malformation. With topical treatment with timolol maleate 0.5% once a day in the affected eye, the lesion regressed completely after 4 months. This child represents the first case of the BRBNS associated with a subconjunctival progressive bleeding necessitating topical treatment despite oral propranolol effectively controlling the cutaneous lesions. We recommend ophthalmic screening of patients with BRBNS in early childhood. For patients with BRBNS-related subconjunctival vascular lesions with subsequent hemorrhage, treatment with a topical β-blocker may be an efficient and harmless treatment option.

Surgical outcomes with high and low pulse energy femtosecond laser systems for cataract surgery

Currently, there is no clear consensus in cataract surgery if low compared to high energy femto-lasers may enable better capsulotomy quality and induce lower inflammatory response. Therefore, the aim of this study was to compare the intra-operative outcomes achieved with high and low pulse energy femtosecond laser systems for cataract surgery. The charts of 200 eyes of 200 patients aged 68.3 ± 10.3 years who had undergone femtosecond laser-assisted cataract surgery using either group 1 high pulse energy: LenSx (Alcon Laboratories) (N = 100) or group 2 low pulse energy: FEMTO LDV Z8 (Ziemer) (N = 100) laser were reviewed retrospectively. Integrity of anterior capsulotomy, classified as (1) complete (free-floating or with minor microadhesions), (2) incomplete and (3) with capsular tears, intraoperative completeness of the clear corneal incisions (CCI, main incision and side port), incidences of intraoperative miosis and incidence of subconjunctival hemorrhage were evaluated and compared between the two groups. The proportion of complete capsulotomies was significantly higher in the group 2 than the group 1 (100% vs 94%; p = 0.03). The incidences of intraoperative miosis (0% vs 19%) and subconjunctival hemorrhage (1% vs 63%) were significantly lower in the group 2 than the group 1 (p < 0.001). Completeness of the main incision was comparable (97% vs 95%; p = 0.721) between the two groups. Although not statistically significant, the completeness of side-port incision was slightly better in the group 2 than the group 1 (91% vs 86%). Low energy laser system performed significantly better in terms of completeness of capsulotomy, intraoperative miosis and sub-conjunctival hemorrhage, compared with high energy laser; the CCI outcomes were comparable.