While the use of chelation for people with symptoms of lead poisoning is widely supported, use in asymptomatic people with high blood lead levels is more controversial. Chelation therapy is of limited value for cases of chronic exposure to low levels of lead. Chelation therapy is usually stopped when symptoms resolve or when blood lead levels return to premorbid levels. When lead exposure has taken place over a long period, blood lead levels may rise after chelation is stopped because lead is leached into blood from stores in the bone; thus repeated treatments are often necessary.People receiving dimercaprol need to be assessed for peanut allergies since the commercial formulation contains peanut oil. Calcium EDTA is also effective if administered four hours after the administration of dimercaprol. Administering dimercaprol, DMSA (Succimer), or DMPS prior to calcium EDTA is necessary to prevent the redistribution of lead into the central nervous system. Dimercaprol used alone may also redistribute lead to the brain and testes. An adverse side effect of calcium EDTA is renal toxicity. Succimer (DMSA) is the preferred agent in mild to moderate lead poisoning cases. This may be the case in instances where children have a blood lead level >25μg/dL. The most reported adverse side effect for succimer is gastrointestinal disturbances. It is also important to note that chelation therapy only lowers blood lead levels and may not prevent the lead-induced cognitive problems associated with lower lead levels in tissue.
A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within 2 weeks. Causes
Mechanical
Increased venous pressure (e.g. extreme g-force, straining, vomiting, choking, coughing or strangling) or from straining due to constipation
External pressure changes:Atmospheric pressure changes due to aircraft altitude changes. Mask squeeze from diving without equalizing mask pressure during descent or from diving deeply in water
Eye injury
Head injury
Laser eye surgery or other eye surgery
Zygoma fracture (results in lateral subconjunctival bleeding)
Medical conditions that cause increased venous pressure:
Whooping cough or other extreme sneezing or coughing
Severe hypertension
Medical conditions that affect blood or blood vessels:
Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
Coagulation disorder (congenital or acquired) including Ebola
Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
LeptospirosisSubconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency),abuse or traumatic asphyxia syndrome. Diagnosis
Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. Management
A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged. References


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