Subconjunctival hemorrhage - Testing: Which of the following is recommended for recurrent cases?

• A. BP only.
• B. BP and bloodwork including PT, PTT, Protein C and S, CBC with differential.
• C. Imaging studies of the orbit.
• D. Visual acuity testing only.

Answer: (B)

When subconjunctival hemorrhages keep returning, look for systemic factors that could predispose to bleeding or vessel fragility. The best approach combines assessing vascular risk and evaluating blood’s clotting ability. Checking blood pressure helps reveal hypertension, a common contributor to recurrent vessel rupture. The blood tests—PT and PTT—evaluate the clotting pathways, while the CBC with differential assesses platelet count and blood cell health. Including tests for protein C and protein S adds screening for inherited or acquired coagulation abnormalities that could influence bleeding risk. Together, this approach directly addresses potential systemic causes rather than focusing only on eye structure or simple vision checks. Other options miss either the vascular component or the hematologic assessment needed to identify why the hemorrhages keep recurring.