When a patient is presented for red and/or bruised ocular tissue, there may be concern for trauma or nonaccidental injury/physical abuse. In a large study of pets presented for traumatic injury, subconjunctival hemorrhage (ie, bleeding between the conjunctiva and sclera) was associated with nonaccidental injury.1
However, there are several nontraumatic causes of subconjunctival hemorrhage that must be ruled out to avoid missing a systemic problem. These causes, in addition to cases of known trauma, were investigated in a recent study. Medical records of 147 dogs with subconjunctival or scleral hemorrhage were retrospectively analyzed. In 81% of dogs, subconjunctival hemorrhage was attributed to a traumatic event (eg, vehicular trauma, animal attack); of these cases, <5% were the result of nonaccidental injury. The remaining 19% of patients were determined to have a primary systemic or ocular problem that led to subconjunctival bleeding. Because a significant number of patients in this study had distinct systemic causes for subconjunctival hemorrhage, it is important to consider diagnoses other than trauma or nonaccidental injury.