Is the site of hemorrhage an indicator of the cause of hemorrhage in cases with non-traumatic subconjunctival hemorrhage?

PURPOSE: To our knowledge, no study has so far assessed in detail the relationships between subconjunctival hemorrhage (SCH) sites and SCH causes in patients with non-traumatic SCH (NTSCH). Therefore, in this study, we aimed to investigate comprehensively these relationships.
METHODS: Four-hundred nineteen cases were included. SCH sites were classified as superior (n = 109), nasal (n = 114), tempo-ral (n = 84), and inferior (n = 112) areas. Etiological factors associated with NTSCH were determined as hypertension, diabetes mellitus, coagulation system disorders, conditions causing sudden venous congestion (CCSVC), and idiopathy. Relationships between SCH sites and causes were analyzed. In addition, evaluations were made according to age (≤60 and >60 years).
RESULTS: In cases aged ≤60 years, nasal site hemorrhage was more frequent than temporal (35.0% vs. 21.7%, P = 0.016) and inferior (35.0% vs. 15.2%, P < 0.001) site hemorrhages. In individuals aged >60 years, inferior site hemorrhage was more fre-quent than superior (39.1% vs. 23.8%, P = 0.012), nasal (39.1% vs. 18.8%, P < 0.001), and temporal (39.1% vs. 18.3%, P < 0.001) site hemorrhages. In cases aged ≤60 years, etiological factors were seen with similar frequency in superior, temporal, and infe-rior site involvements (P > 0.05), while hemorrhage in nasal site was most frequently associated with CCSVC (46.1%, P < 0.01). In individuals aged >60 years, etiological factors were observed with similar frequency in superior, nasal, and temporal site involvements (P > 0.05), while hemorrhage in inferior site was most frequently associated with hypertension (48.1%, P < 0.02).
CONCLUSION: We determined that nasal NTSCH was most frequently associated with CCSVC in cases aged ≤60 years, while inferior NTSCH was most frequently associated with hypertension in individuals aged >60 years.