H11.411-413 Vascular Abnormalities of Conjunctiva

Vascular abnormalities of the conjunctiva are focal dilations of the conjunctival vessels.  Patients usually are asymptomatic, but can often present with a red spot on the eye.  These microaneurysms have been associated with retinal findings so it is important to look for an underlying cause.

Structural Damage to the Eye

• Constant movement of the abnormal vasculature can cause avulsion of the blood vessels resulting in subconjunctival hemorrhage

Functional Damage to the Eye

• None

The main goal of the diagnostic evaluation in a patient with vascular abnormalities of the conjunctiva is to accomplish the following:

• Determine the underlying associated systemic etiology of the vascular abnormalities of conjunctiva
• Prescribe a treatment program to treat the underlying condition

Patient History

Patients usually come in because they notice the vascular abnormalities, but are otherwise asymptomatic in the early stages of the growth.

External Ocular Examination with Biomicroscopy

• Abnormal conjunctival vessel diameter
• Vessel tortuosity
• Distended vessels
• Damaged vessels
• Sacculated vessels
• Microaneurysms
• Blood sludging

Clinical Appearance of the Retina

Since vascular abnormalities of the conjunctiva can be associated with vascular related systemic diseases, it is important to rule out retinopathy from diabetes, hypertension and sickle cell anemia. 

DIAGNOSTIC TESTS

External Ocular Photography

• To document the progress or lack of progress of the vascular abnormalities of the conjunctiva
• To document the delivery of medical treatment
• To document the response to treatment

No specific classification exists for vascular abnormalities of the conjunctiva.

A finding of vascular abnormalities of the conjunctiva may suggest the presence of one or more of the following associated conditions:

Diabetes mellitus

• Patients with diabetes will have problems with their microvasculature systems and tend to hemorrhage easily 

Hypertension

• Patient’s vasculature can become engorged after spikes in blood pressure causing bruising and rupture of the blood vessels

Sickle Cell Anemia

• These patients can show sausaging, blood sludging, vessel tortuosity, abnormal vessel diameter, and microaneurysms

Arteriosclerosis

• Plaques dislodged in various parts of the head and around the eyes can result in vascular abnormalities

Carotid occlusion

• Occlusion of the major artery can cause vascular abnormalities

Treatment of conjunctival vascular abnormalities focuses on determining the underlying systemic etiology causing the condition.

Palliative Treatments

• Patient education about the link between systemic vascular disease and the conjunctival vascular abnormalities
• Artificial tears for patients with foreign body sensations

This is no specific treatment for the vascular abnormality and surgical removal is contraindicated in most cases.

1.  Lee, R.  Holze, E.  Peripheral Vascular Hemodynamics in the Bulbar Conjunctiva of Subjects with Hypertensive Vascular Disease.  The National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC436287/.  Last accessed November 16, 2014.
2.  Corneal and Conjunctival Foreign Bodies.  The Wills Eye Manual (Fifth Edition).  16-18.