|Year : 2016 | Volume
| Issue : 3 | Page : 96-97
Bilateral Subconjunctival Hemorrhage: A New Presentation of Stricture Urethra
Mukesh Chandra Arya, Mayank Baid, Ruchi Mittal, Rajeev Kumar
Department of Urology, S.P. Medical College, Bikaner, Rajasthan, India
|Date of Web Publication||4-Aug-2016|
Mukesh Chandra Arya
Department of Urology, S.P. Medical College, Bikaner - 334 001, Rajasthan
Source of Support: None, Conflict of Interest: None
Bilateral subconjunctival hemorrhage is usually caused by conjunctivitis and trauma. Other causes are straining, sneezing, coughing, or vomiting. We report here two cases of severe stricture urethra who presented to us with bilateral subconjunctival hemorrhage. Both patients had to strain for more than half an hour to empty bladder once, since many months. On evaluation both patients were found to have very narrow segment stricture urethra, underwent subsequent augmented urethroplasty and in about 3 weeks subconjunctival hemorrhage resolved on its own. We conclude that bilateral subconjunctival hemorrhage could be potential presenting sign of stricture urethra in patients who strain severely to empty their bladder.
Keywords: Stricture, Subconjunctival hemorrhage, urethra
|How to cite this article:|
Arya MC, Baid M, Mittal R, Kumar R. Bilateral Subconjunctival Hemorrhage: A New Presentation of Stricture Urethra. J Integr Nephrol Androl 2016;3:96-7
|How to cite this URL:|
Arya MC, Baid M, Mittal R, Kumar R. Bilateral Subconjunctival Hemorrhage: A New Presentation of Stricture Urethra. J Integr Nephrol Androl [serial online] 2016 [cited 2019 Dec 9];3:96-7. Available from: http://www.journal-ina.com/text.asp?2016/3/3/96/187797
| Introduction|| |
Subconjunctival hemorrhage (SCH) is a common benign condition of the eye that has characteristic features, such as the painless acute appearance of a sharply circumscribed bleeding underneath the conjunctiva in the absence of discharge and inflammation in contagious areas.  Histologically, SCH can be defined as hemorrhage between the conjunctiva and episclera, and the blood elements are found in the substantia propria of the conjunctiva when a subconjunctival vessel breaks. 
Bilateral SCH is usually caused by conjunctivitis and trauma. Other causes are straining, sneezing, coughing, or vomiting.  In available literature, bilateral SCH in association with stricture urethra has been reported only once by Mokrohisky and Kesselman,  who reported a case of subconjuctival hemorrhage in a child secondary to valsalva effect. The child had a history of urethral stricture and increased straining during voiding before the development of eye bruising and SCH. Here, we report two cases of severe stricture urethra who presented to us with bilateral SCH.
| Case report|| |
Two patients presented to us with bilateral SCH in the outpatient department [Figure 1]a and b. The first patient was a known case of carcinoma bladder who had repeated transurethral resections and complained of bilateral red eyes for 5 months. The second patient was a known case of balanitis xerotica obliterans, and he had a similar complaint of reddish eyes for 4 months. Both patients had to strain for more than half an hour to empty bladder once, for the last many months. There was no history of trauma or abnormal bleeding. Ophthalmology opinion was taken, but no other cause of bilateral SCH was noted. We did complete coagulation profile (bleeding time, clotting time, prothrombin time, and activated partial thromboplastin time) in both the patients and were normal. They were not on thrombolytic therapy. On evaluation, both patients were found to have very narrow segment urethral stricture. Both these patients underwent subsequent augmented urethroplasty. In about 3 weeks time, SCH resolved on its own in both the patients. The retrograde urethrogram images of the first case have been depicted before and after buccal mucosal graft ventral onlay urethroplasty [Figure 2]a and b.
|Figure 1: Bilateral subconjunctival hemorrhage. (a) Patient with carcinoma bladder. (b) Patient with balanitis xerotica obliterans|
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|Figure 2: (a) Retrograde urethrogram of a patient with carcinoma bladder showing bulbar urethral stricture. (b) Retrograde urethrogram of patient with carcinoma bladder after buccal mucosal graft ventral onlay urethroplasty|
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We did not find any significant difference between the presentation of these two patients. In addition, there was no difference when these patients were compared to other patients with similar narrow urethral stricture except for bilateral SCH. SCH in such patients may result from severe straining during micturition. The resultant rise in intra-abdominal pressure due to severe straining causes increased pressure in the subconjunctival veins and capillaries leading to their rupture and SCH. This is the plausible explanation of SCH associated with sneezing, coughing,  constipation, and vomiting. There may be associated rectal prolapse or hernia in some cases. Such SCH usually spontaneously resolves in 2-3 weeks if the offending cause is treated.
Hence, we conclude that bilateral SCH could be a potential presenting sign of stricture urethra in patients who strain severely to empty their bladder.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Leibowitz HM. The red eye. N Engl J Med 2000;343:345-51.
Yanoff M, Fine BS. Conjunctiva. Ocular Pathology. Maryland Heights, MO: Mosby; 1996. p. 206-7.
Tarlan B, Kiratli H. Subconjunctival hemorrhage: Risk factors and potential indicators. Clin Ophthalmol 2013;7:1163-70.
Mokrohisky ST, Kesselman NE. Valsalva effect may mimic child abuse. Pediatrics 1991;88:420.
[Figure 1], [Figure 2]