A warfarin-induced subconjunctival hemorrhage.
BACKGROUND
Patients who are on warfarin therapy may present with a variety of ocular side effects, particularly hemorrhages. These ocular events may be the only indication that the patient is at risk for serious sequelae, including hemorrhagic stoke.


METHODS
A 76-year-old patient, taking warfarin, presented with a subconjunctival hemorrhage. Four days later the hemorrhage worsened, and the patient developed a headache. Blood testing revealed an elevated International Normalization Ratio (INR) and prothrombin time (PT). The patient's primary care physician adjusted the patient's medication dosage, and the patient's signs and symptoms improved.


CONCLUSIONS
Patients on warfarin therapy who present with ocular bleeding require immediate blood work and consultation with their primary care provider or cardiologist. The optometrist should be aware of the ocular and systemic sequelae of warfarin, its possible drug interactions, and potential controversies regarding cataract surgery in these patients.
Bodack
Marie I
MI
State University of New York State College of Optometry, New York, New York, USA. marie.bodack@cchmc.org
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D003229:Conjunctival Diseases / Q000139:chemically induced* / Q000473:pathology; D003937:Diagnosis, Differential; D005130:Eye Hemorrhage / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012720:Severity of Illness Index; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin