Subconjunctival hemorrhages are evident in the following cases except ?

Ans. is 'd' i.e., Pellagra Subconjunctival haemorrhage Occurs due to the rupture of small vessels. The condition, though unsightly, is tril. This can occur spontaneously in elderly people with fragile vessels or those with systolic hypeension or after local ocular trauma or eye surgery. Very minute ecchymoses, or possibly thromboses, are seen in severe conjunctivitis; large extravasations accompany severe straining, especially in old people, as on lifting heavy weights or vomiting. They are not infrequently seen in children with whooping cough and may occur in scurvy, blood diseases such as purpura, or in malaria. Recurrent subconjunctival haemorrhages warrant investigations for a bleeding diatheses or leukaemia. The differential diagnosis includes Kaposi sarcoma. More serious are the large sub-conjunctival ecchymoses which seep forwards from the fonix following head injuries. They are due to an extravasation of blood along the floor of the orbit, secondary to a fracture of the base of the skull. In fractures of the sphenoid the blood appears later on the temporal side than elsewhere. Haemorrhages also result from severe or prolonged pressure on the thorax and abdomen, as in persons squeezed in a crowd or by machinery. The blood gradually changes colour and gets absorbed in 1 to 3 weeks without treatment. The use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided and if mild ocular irritation is present, aificial tears can be prescribed four to six times a day.