Which of the following is NOT a typical etiology of subconjunctival hemorrhage?

• A. Sickle Cell anemia
• B. Diabetes
• C. Aspirin use
• D. Valsalva maneuver

Answer: (B)

Subconjunctival hemorrhage happens when a tiny conjunctival vessel ruptures, causing a bright red patch on the white of the eye. The common triggers are situations that either suddenly raise venous pressure or directly injure the surface: a Valsalva maneuver from coughing, sneezing, vomiting, or heavy lifting; eye rubbing or minor trauma; and conditions or medications that affect clotting, such as aspirin use, which can make even small bleeds more noticeable or longer to stop.

Sickle cell anemia can contribute to subconjunctival hemorrhages because of fragile vessels and vaso-occlusive events that can cause bleeding under the conjunctiva. A Valsalva maneuver similarly increases pressure enough to rupture a surface vessel. Aspirin use impairs platelet function, increasing bleeding tendency.

Diabetes, while it damages microvasculature in other parts of the eye (notably the retina), does not typically present as a usual cause of subconjunctival hemorrhage. It isn’t associated with the sudden rupture of a conjunctival vessel in the absence of another triggering factor, making it not a typical etiology in this scenario.