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Painless, bloody-looking flat lesion on sclera. No discharge, no lacrimal gland deficit. Something about which to be concerned?

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Painless, quarter inch sized, bloody-looking un-raised lesion on sclera, abuts lens, with attached trailing prominent blood vessel 3/16 inch long. Vessel may be filling lesion. Noticed two days ago, stable in size, no known precipitating event/trauma. Remaining sclera unremarkable, normal coloration and vascularization. Long time wearing of glasses. No contacts. No discharge in ocular region. Normal surface moisture, no lacrimal gland deficit. Normal heart rate, no head ache, normal BP. I am a RN nurse graduate. My wife only has two eyes. I don't play around, especially regarding something like eyes. Something about which to be concerned?
Posted Wed, 11 Apr 2012 in Vision and Eye Disorders
Answered by Dr. Mihir Shah 1 hour later


Thanks for the query.

I would be able to understand the nature of the lesion and comment about the condition better if you are can send me the photograph of the affected eye. You can upload the close up picture of the affected eye via the upload option provided here.

From what you have described, it is a painless flat lesion on the sclera near the cornea. There can be two possibilities:

A) Pterygium - A pterygium is a non-cancerous growth of the clear, thin tissue (conjunctiva) that lays over the white part of the eye (sclera). One or both eyes may be involved. The cause of it is unknown, but is more common in people with excess outdoor exposure to sunlight and wind, such as those who work outdoors.
Risk factors are exposure to XXXXXXX dusty, XXXXXXX or windblown areas. Farmers, fishermen, and people living near the equator are often affected.

B) Pingecula - It is seen as a yellow white deposit on the conjunctiva adjacent to the limbus (the junction between the cornea and sclera). It is to be distinguished clinically from pterygium.

Kindly post the picture of the eye to be able to comment better.

Awaiting your reply.

Best regards,
Dr.Mihir Shah
Above answer was peer-reviewed by
Follow-up: Painless, bloody-looking flat lesion on sclera. No discharge, no lacrimal gland deficit. Something about which to be concerned? 12 hours later
Dr. Shah,
Firstly, I do not want to insult you. I ask a lot of questions and posses more medical knowledge than many due to my education as a registered nurse graduate. Your possible diagnoses don't seem to fit according to presentation. The lesion completely obscures the sclera. The fissure(?) is filled with blood or something visually similar, slightly dark in nature, very slightly. Aterial blood is bright red, but as the fissure fills, the trapped blood will age. To me, no yellow white deposit is present.

I am slightly familiar with a pterygium as I am being monitored for one. Again, not trying to insult you. From what my doctor has told me and what I have read, pterygium usually present as a pinkish film through which the sclera can often be or are usually(?) viewed. I reiterate, the lesion is bloody in nature and completely obscures the sclera. This is an acute presentation, noticed three days ago.

A good analogy would be the lesion is a lake with one prominent feeder river that widens as it nears the lake. Would a ptergyium present so quickly with the quarter inch diameter size? To me, the presentation is somewhat reminiscent of an intravenous line that extravasates into surrounding tissue, but with blood instead of IV solution. I will try to get a camera to back me up regarding presentation. My visual description is 'dead on.'
Answered by Dr. Mihir Shah 33 minutes later

Thank you for the follow-up and making things clear.

Your description is very good, I appreciate that.

If it is an cute onset condition, the possibilities could be a subconjunctival hemorrhage, or an episcleritis. A close up photograph of the eye will really help.

Hope I have answered your query. Please accept my answer if you do not have any further concerns.

Wishing you good health.

Best regards,

Dr.Mihir Shah
Above answer was peer-reviewed by
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