Photo Rounds

Red eyes following sneezing episode

A young man visited his family physician (FP) at the urging of his family and friends because both of his eyes were red. He said that he was allergic to cats, and the day before he’d visited a relative who had a cat. During this visit, he had a “sneezing fit.” He took an antihistamine and had not been around cats since. On exam, his vision was 20/20 bilaterally (with his glasses) and his funduscopic exam was normal.

What’s your diagnosis?


The FP diagnosed bilateral subconjunctival hemorrhages. The bright red color that goes up to the cornea but leaves a small white ring of uninvolved tissue at the limbus is a classic finding for subconjunctival hemorrhage. While a subconjunctival hemorrhage appears concerning, it is not dangerous to the eye.

When caring for a patient who presents in this manner, it’s important to check for uncontrolled hypertension. You’ll also need to ask about other bleeding so that you can rule out clotting problems.

In most cases, the subconjunctival hemorrhage is caused by mild trauma including sneezing and coughing. In this case, the FP reassured the patient that his subconjunctival hemorrhages would resolve spontaneously. She also suggested that the patient take antihistamines prophylactically before being exposed to a cat.

Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Paul Comeau. This case was adapted from: Chumley H, Usatine R. Differential diagnosis of the red eye. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:163-168.

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