Family Nurse Practitioner Exam

A 70-year-old male complains of a bright red spot in his left eye. What is the most likely diagnosis?

1. Corneal abrasion

2. Acute bacterial conjunctivitis

3. Acute uveitis

4. Subconjunctival hemorrhage

The correct answer is: Subconjunctival hemorrhage

The presence of a bright red spot in the eye of a 70-year-old male is most consistent with a subconjunctival hemorrhage. This condition occurs when small blood vessels in the conjunctiva break, leading to bleeding and the appearance of a bright red area on the white part of the eye (sclera). It is often caused by minor trauma, increased pressure (as seen with coughing or straining), or can occur without a clear cause, particularly in older adults whose connective tissue may be more fragile. On the other hand, corneal abrasion would typically present with symptoms of pain, tearing, and light sensitivity, not just a localized red area. Acute bacterial conjunctivitis would generally involve symptoms such as purulent discharge, redness, and irritation rather than a distinctly bright red spot. Acute uveitis might present with symptoms such as eye pain, photophobia, and blurred vision, along with redness but is accompanied by a more diffuse redness or discomfort rather than a defined bright red area. Therefore, the isolated bright red spot indicates a localized hemorrhage rather than an infectious or inflammatory condition, making subconjunctival hemorrhage the most likely diagnosis.