Bleeding on and around the eyeball

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Examination of the eye of a cat with an ophthalmoscope

Bleeding in and around the eye
Bleeding on or in the eye includes Bleeding into the conjunctiva, anterior chamber (hyphema), vitreous body, or into the surrounding tissues. Causes are often trauma, high blood pressure, coagulation disorders, or Inflammatory conditions. Any Bleeding in the eye requires clarification, as vision loss may occur.

A bloody eye in pets refers to various forms of Bleeding that can occur on or around the eye. These Bleeding can affect different structures of the eye and vary in their severity and clinical significance. The anatomical features of the eye in dogs and cats play an important role in understanding these diseases.

The eye of our pets consists of various structures that can be affected by Bleeding: the conjunctiva, the anterior chamber of the eye, the vitreous body, the retina, and the structures around the eye, including the eyelids and the orbit (orbital cavity). Depending on the affected structure, we distinguish between different types of eye Bleeding, which have different causes, symptoms, and treatment approaches.

In dogs and cats, there are anatomical differences in the structure of the eye that can influence the occurrence and course of eye Bleeding. Cats have the tapetum lucidum, a reflective layer behind the retina, which can be affected differently by Bleeding than in dogs. In addition, brachycephalic (short-headed) dog and cat breeds such as pugs, French bulldogs, or Persian cats have an increased risk of certain eye problems due to their skull structure, as their eyes often protrude more (Bulging eyeballs (exophthalmos)) and are therefore more susceptible to injury.

Causes

The causes of eye bleeding in pets are varied and can be divided into traumatic causes, systemic diseases, and primary eye diseases.

Traumatic causes are particularly common and include blunt traumas from collisions, falls, or blows, which can lead to bleeding under the conjunctiva (subconjunctival bleeding) or in the anterior chamber of the eye (hyphema). Foreign body in the eye, Scratching injuries from other animals or plant parts, and bite injuries can also cause bleeding. In cats, Scratching injuries from conspecifics are a common cause of eye bleeding.
Bleeding under the conjunctiva of the eye, even if it affects the entire eyeball, is painless and does not require treatment. They do not impair vision. They are also caused by injuries to small blood vessels in the conjunctiva.
On the other hand, there may be a serious injury, especially if there has been Bleeding inside the eye at the same time.
A Bone fracture near the eye or even a skull fracture can also lead to severe bleeding under the skin in the eye region. In the event of a skull fracture, both eye regions may be affected at the same time. This creates a “glasses formation” around the eyes (monocle Bleeding or raccoon eyes). Then blood often comes out of the nose at the same time.
Bleeding inside the bony orbital cavity behind the eyeball can lead to severe Swelling, so that the eyeball is pushed forward and the eyelids may not be able to close.

In systemic diseases, high blood pressure is particularly important, which is common in older cats with kidney disease and can lead to retinal Bleeding. Blood coagulation disorders, whether due to genetic factors such as von Willebrand disease in dogs or acquired through poisoning (e.g. with rat poison), can also promote eye Bleeding. Infectious diseases such as leptospirosis in dogs or feline leukemia virus (FeLV) in cats can be associated with eye Bleeding. Autoimmune diseases such as systemic lupus erythematosus can lead to Inflammatory conditions of the vessels (vasculitis), which can result in Bleeding.

Primary eye diseases such as glaucoma (increased intraocular pressure) can lead to vascular rupture and Bleeding due to the increased pressure. Uveitis (Inflammatory conditions of the middle layer of the eye) can be associated with Bleeding in the anterior chamber of the eye. Retinal detachments are often associated with Bleeding, and tumors in or on the eye can lead to Bleeding due to their abnormal vascular formation or tissue destruction.

The causes differ somewhat between dogs and cats. In cats, hypertensive retinopathies due to high blood pressure are particularly common, while in dogs, traumatic causes and coagulation disorders are the main focus.

Symptoms

Bleeding on/around the eye

Typical Symptoms:

  • Red Bleeding in the conjunctiva/sclera, hematoma on the eyelid
  • “Red eye”, possibly Pain/sensitivity to light
  • Possible after trauma, Scratching, coagulation disorder

Alarm signs:

  • Blood in the eye (hyphema), sudden Visual disturbances
  • Severe Pain, corneal opacity, pupillary changes
  • Suspected proptosis or deep eyelid injury
  • Bleeding + further hematomas/petechiae on the body

Escalation/course:

  • Increasing cloudiness/Pain within hours → Ulcus/uveitis/glaucoma possible
  • Hyphema: Risk of secondary glaucoma in hours–days → urgent

Persistent Bleeding > 24 h → clarification of coagulation/hypertension

The symptoms of a bloody eye vary depending on the type, location, and severity of the Bleeding. Accurate observation of these symptoms is important for pet owners to assess the urgency of a visit to the vet.

In the case of subconjunctival Bleeding, the conjunctiva appears bright red to dark red, whereby the Bleeding can be flat or punctiform. These Bleeding are usually painless and do not impair vision. The animal usually does not show any Behavioral changes, and the Bleeding can affect the entire visible part of the eyeball or only part of it.

A hyphema, i.e. blood in the anterior chamber of the eye, appears as a reddish discoloration behind the cornea, which, depending on the severity, can partially or completely cover the iris. Affected animals often show signs of Pain such as increased blinking, watery eyes, or sensitivity to light. Vision may be impaired, which can be manifested by more cautious movements or bumping into objects.

Bleeding in the vitreous body or in the retina is often not directly visible from the outside, but can lead to sudden Visual disturbances. Affected animals may appear disoriented, run into objects, or have Difficulty jumping. In the case of extensive retinal Bleeding, there may be pupillary dilation that does not respond to light.

Bleeding in the orbital cavity (orbital Bleeding) leads to Bulging eyeballs (exophthalmos) and can be accompanied by Swelling of the surrounding tissues. The eyelids may be swollen and may no longer be able to close completely. These Bleeding are often painful and can lead to Fever and general malaise.

In the case of traumatic injuries, additional symptoms such as bruises or hematomas around the eye (“blue eye”), Swelling of the eyelids, or injuries to the cornea may occur. In the case of severe traumas, a “glasses formation” can occur around both eyes (monocle Bleeding or raccoon eyes), especially if there is a skull fracture. In such cases, blood often comes out of the nose as well.

First Aid

  1. Cooling with cold compresses helps to stop the Bleeding under the skin and reduce Swelling.
  2. Cooling should begin as soon as possible after the injury. Under no circumstances should pressure be exerted on the eyeballs themselves.
  3. Repeated cooling is useful for the next 24 hours.
  4. After two days, a local application of heat (compresses) helps to reduce the bruise.

Diagnosis

The of eye requires a thorough examination and, if necessary, further diagnostic procedures to determine the cause and extent of the.

The clinical examination begins with a general assessment of the animal, followed by a targeted examination of the eye and its surroundings. The veterinarian looks for signs of , , or asymmetries between the two eyes. With a , the anterior segments of the eye can be examined in detail to assess subconjunctival or hyphema.

(examination with an ophthalmoscope) enables the assessment of the fundus of the eye and can reveal retinal , retinal detachments, or changes in the blood vessels. In cats suspected of having high blood pressure, this examination is particularly important because hypertensive retinopathies often lead to retinal.

(measurement of intraocular pressure) is important to rule out or confirm glaucoma as a cause or consequence of the. Elevated intraocular pressure can be both a cause and a consequence of eye and requires immediate treatment.

Imaging techniques such as of the eye are particularly valuable when the transparency of the ocular media is limited by and a direct assessment of the fundus is not possible. If orbital or skull fractures are suspected, computed tomography (CT) or magnetic resonance imaging (MRI) may be necessary.

Laboratory tests include a complete blood count, coagulation parameters, and biochemical profiles to identify systemic causes such as blood clotting disorders, infections, or organ diseases. In cats suspected of having high blood pressure, blood pressure measurement is essential, ideally in a quiet environment to minimize stress-related distortions.

The must differentiate between different types of eye and identify their causes in order to enable targeted treatment.

Further veterinary measures

The treatment of eye Bleeding depends on the cause, the extent of the Bleeding and the affected structures of the eye. It includes both first aid measures and specific veterinary treatments.

As a first aid measure for traumatically induced eye Bleeding, cooling with cold compresses is helpful to stop the Bleeding and reduce Swelling. This should begin as soon as possible after the injury, and pressure must never be exerted on the eyeball itself. Cooling can be repeated at regular intervals for the first 24 hours. After about two days, a local application of heat can promote the reduction of the bruise.

In the case of subconjunctival Bleeding that has no further complications, no specific treatment is often necessary, as it is usually absorbed on its own within 1–2 weeks. However, the veterinarian may prescribe artificial tears to moisten the eye and protect it from irritation.

A hyphema requires more intensive treatment. Drug therapies include anti-inflammatory drug eye drops (corticosteroids or non-steroidal anti-inflammatory drugs) to reduce Inflammatory conditions, as well as pupil-dilating agents (mydriatics) to prevent adhesions between the iris and lens. If intraocular pressure is increased, blood pressure-lowering drugs are used.

In the case of severe Bleeding, especially if it is associated with a trauma or glaucoma, inpatient treatment with intravenous medication may be necessary. In some cases, a surgical intervention may be necessary to remove blood from the anterior chamber of the eye (paracentesis) or to repair other structures.

The treatment of underlying systemic diseases is crucial for long-term success. In cats with high blood pressure, antihypertensive drugs such as calcium channel blockers (e.g. amlodipine) or ACE inhibitor are used. In the case of coagulation disorders, substitution therapy with coagulation factors or vitamin K may be necessary.

In the case of severe eye injuries with extensive Bleeding that has led to irreversible damage, removal of the eye (enucleation) may be the best option in some cases to save the animal Pain and prevent the spread of infections.

Prognosis and aftercare

The Prognose for eye Bleeding depends largely on the cause, the extent of the Bleeding, the affected structures, and the speed of treatment. Careful aftercare is crucial for long-term treatment success.

The Prognose for superficial subconjunctival Bleeding is usually excellent. These Bleeding usually resolve completely within 1–2 weeks without leaving any permanent damage. Regular monitoring by the veterinarian is nevertheless important to ensure that no underlying problems have been overlooked.

The Prognose for a hyphema should be more cautious. Smaller Bleeding in the anterior chamber of the eye can completely regress if treated early and appropriately. In the case of massive Bleeding or if the blood remains in the anterior chamber of the eye for a long period of time, there is a risk of complications such as glaucoma, synechiae (adhesions of the iris), or corneal damage, which can permanently impair vision.

Retinal Bleeding has a variable Prognose. Small, punctiform Bleeding can heal without leaving any permanent damage, while extensive Bleeding can lead to Scar tissue formation and permanent Visual disturbances. In cats with hypertensive retinopathy, vision can be partially restored if high blood pressure is quickly controlled.

Aftercare includes regular check-ups with the veterinarian to monitor the healing process and identify possible complications early on. Depending on the cause of the Bleeding, these check-ups can take place at short intervals (initially daily or weekly) or over longer periods of time (monthly or quarterly).

Home monitoring by the pet owner is an important part of aftercare. Pet owners should watch out for signs of deterioration, such as increasing redness, Swelling, discharge, Pain, or Behavioral changes that could indicate Visual disturbances. Photo documentation of the healing process can be helpful in objectively assessing changes.

In the case of underlying systemic diseases such as high blood pressure or coagulation disorders, long-term treatment and monitoring are necessary to avoid relapses. Regular blood pressure measurements, blood tests, and adjustments to medication may be necessary.

Summary

Eye Bleeding in dogs and cats can affect various structures of the eye and have different causes, from traumatic injuries to systemic diseases. The clinical presentation varies depending on the type and location of the Bleeding, from painless subconjunctival Bleeding to painful orbital Bleeding with Bulging eyeballs (exophthalmos).

The diagnosis requires a thorough ophthalmological examination and, if necessary, further diagnostic procedures such as imaging and laboratory tests. The treatment depends on the cause and severity of the Bleeding and can range from simple first aid measures to complex surgical procedures.

The Prognose depends on various factors, including the affected structures, the extent of the Bleeding, and the speed of treatment. Careful aftercare is crucial for long-term treatment success and may include regular check-ups and long-term medication.

Pet owners play an important role in the early detection of eye and follow-up care. They should watch for signs of eye problems and seek veterinary attention immediately if they suspect eye. Preventive measures such as controlling risk factors and regular veterinary check-ups can help reduce the risk of eye.

Outlook on current research

Research in veterinary is continuously advancing, leading to improved and treatment options for eye in pets.

New imaging techniques such as optical coherence tomography (OCT) enable high-resolution imaging of the and other eye structures, improving the and monitoring of retinal. This non-invasive technique is increasingly used in specialized veterinary facilities and allows for a more precise assessment of damage and healing processes.

In the field of drug development, new active ingredients are being researched that can be used more specifically and with fewer side effects in eye diseases. Antifibrinolytic substances such as tranexamic acid are already being used successfully in human medicine for eye and are increasingly being used in veterinary medicine.

Minimally invasive surgical techniques such as (removal of the vitreous body) with small instruments are being further developed and can be used for severe vitreous to remove the blood and restore vision. These techniques require specialized training and equipment but are becoming increasingly available in veterinary centers.

Research into genetic factors that lead to blood clotting disorders and an increased could lead to more targeted and treatment strategies for certain breeds in the future. Genetic tests could help identify at-risk animals early and take preventive measures.

Regenerative therapies such as the use of growth factors or stem cells are being researched to promote the healing of eye injuries and reduce. These approaches are still in experimental stages but could offer new treatment options in the future.

The development of improved blood pressure monitors and protocols for pets could improve the early detection and monitoring of high blood pressure in cats, thereby contributing to the of hypertensive retinopathies.

Frequently asked questions (FAQs)

  1. Is subconjunctival Bleeding dangerous in dogs?
    Subconjunctival Bleeding is usually not dangerous and heals within 1–2 weeks without treatment. However, they should be examined by a veterinarian to rule out more serious causes.
  2. Can a bloody eye in my cat be a sign of high blood pressure?
    Yes, especially in older cats, high blood pressure is a common cause of retinal Bleeding. These can cause sudden Visual disturbances and require rapid treatment to avoid permanent damage.
  3. How can I tell if my dog’s eye Bleeding is an emergency?
    Signs of an emergency include severe Pain, sudden Visual disturbances, severe Swelling, blood inside the eye, or simultaneous Bleeding from the nose or mouth. In these cases, you should see a vet immediately.
  4. Can eye Bleeding in my pet heal on its own?
    Superficial subconjunctival Bleeding often heals on its own. However, Bleeding inside the eye or in the orbital cavity usually requires veterinary treatment to avoid complications.
  5. Which dog breeds have an increased risk of eye Bleeding?
    Brachycephalic breeds such as pugs, French bulldogs, or Pekingese have an increased risk of injury due to their protruding eyes. Breeds with known coagulation disorders such as Dobermans or German Wirehaired Pointers may also be more susceptible.
  6. Can medications cause eye Bleeding in my pet?
    Yes, certain medications such as blood thinners (e.g. aspirin) or non-steroidal anti-inflammatory drugs can increase the risk of Bleeding. Always tell your vet about all the medications your animal is receiving.
  7. How can I prevent eye Bleeding in my pet?
    Preventive measures include avoiding fights and dangerous play situations, regular veterinary check-ups, controlling high blood pressure in predisposed animals, and designing the environment safely to avoid injuries.
  8. Is surgery always necessary for eye Bleeding?
    No, many eye Bleeding can be treated conservatively with medication. Surgical interventions are only necessary in severe cases, such as massive Bleeding in the anterior chamber of the eye or severe injuries.
  9. Can eye Bleeding lead to blindness?
    The risk of blindness depends on the type and extent of the Bleeding. While subconjunctival Bleeding rarely leads to vision loss, untreated retinal Bleeding or severe vitreous Bleeding can cause permanent Visual disturbances.
  10. How long does it take for eye Bleeding to heal in cats and dogs?
    The healing time varies depending on the type of Bleeding. Subconjunctival Bleeding typically heals within 1–2 weeks, while Bleeding inside the eye can take several weeks to months to fully resolve.

Literature

  1. Roat, M. I.: Subconjunctival Bleeding. https://www.msdmanuals.com/de-de/profi/augenkrankheiten/krankheiten-der-binde-und-lederhaut/subkonjunktivale-blutungen
  2. Suter, P.F., Niemand, H. G. u. Arnold-Gloor, S.: Practical course in canine medicine. Georg Thieme Verlag 2006.
  3. Burk, A. u. R. Burk: Checklist Ophthalmology (E-Book EPUB), 6th completely revised and expanded edition 2018 632 pages, 343 illustrations, ePub ISBN: 9783132420588
  4. Gould D, McLellan GJ. BSAVA Manual of Canine and Feline Ophthalmology. 3rd ed. Gloucester: British Small Animal Veterinary Association; 2019.
  5. Maggio F, Parry N. Feline hypertensive retinopathy. Journal of Feline Medicine and Surgery. 2020;22(8):713-722.
  6. Ledbetter EC, Gilger BC. Diseases and Surgery of the Canine Cornea and Sclera. In: Gelatt KN, editor. Veterinary Ophthalmology. 6th ed. Hoboken: Wiley-Blackwell; 2021. p. 1082-1164.
  7. Plummer CE, Regnier A, Gelatt KN. The Canine Glaucomas. In: Gelatt KN, editor. Veterinary Ophthalmology. 6th ed. Hoboken: Wiley-Blackwell; 2021. p. 1173-1236.