Contributor: Johanna M. Dijkstal, MD
This an 86 year old male with a history of primary open angle gluacoma and macular degeneration who presented after a mechanical fall leading to minor blunt trauma of the right eye. His medication list included aspirin, clopidogrel, and coumadin. Upon presentation to an outside hospital he was noted to have no orbital fractures on CT. Visual acuity in this right eye was 20/100 down from a baseline of 20/40. Upon slit lamp examination he had periorbital ecchymosis, 360 degrees subconjunctival hemorrhage, and a large elevated subconjunctival hematoma inferonasally. There was no evidence of open globe, but he had moderate corneal punctate epithelial erosisons. Interestingly the patient reported the subconjunctival hematoma did not develop until one week after his fall at which time is acutely became elevated and he was most bothered by the inability to close his lids leading to exposure. He was treated with a pressure patch twice daily and lubricating ointment.
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