Subconjunctival Hemorrhage

Overview

A subconjunctival hemorrhage occurs when a small blood vessel breaks just underneath the clear surface of your eye (conjunctiva). The conjunctiva can't absorb blood very quickly, so the blood gets trapped, creating a bright red patch on the white part of the eye (sclera). Despite its dramatic appearance, a subconjunctival hemorrhage is usually harmless and doesn't affect vision.

This condition is similar to a bruise on the skin, except it appears on the eye's surface. The trapped blood may look alarming, but it's typically painless and doesn't cause any vision problems. The hemorrhage may cover a small area or spread across the entire white of the eye, creating a solid red appearance that can be quite striking.

Subconjunctival hemorrhages are common and can occur at any age. They often happen spontaneously without any obvious cause, and many people don't realize they have one until they look in the mirror or someone points it out. The condition usually resolves on its own within one to two weeks as the body gradually reabsorbs the blood.

Symptoms

The primary sign of a subconjunctival hemorrhage is a bright red patch on the white of the eye. Most people experience no symptoms beyond the visible blood, though some may have mild discomfort.

Common Symptoms

What You Won't Experience

• Vision changes or blurriness
• Discharge from the eye
• Sensitivity to light (photophobia)
• Actual bleeding from the eye
• Severe pain

Causes

Subconjunctival hemorrhages occur when tiny blood vessels in the conjunctiva break. Often, no specific cause can be identified, but several factors can trigger this bleeding:

Common Causes

• Sudden increase in blood pressure: From coughing, sneezing, straining, or vomiting
• Eye trauma: Even minor injuries like rubbing the eye too hard
• Blood-thinning medications: Aspirin, warfarin, or other anticoagulants
• High blood pressure: Uncontrolled hypertension
• Diabetes: Can affect blood vessel integrity

Other Possible Causes

• Heavy lifting or straining during bowel movements
• Violent coughing or sneezing fits
• Eye surgery or injections
• Blood clotting disorders
• Vitamin K deficiency
• Contact lens use (rarely)
• Certain systemic infections

Spontaneous Occurrence

In many cases, subconjunctival hemorrhages occur spontaneously without any identifiable cause. The blood vessels in the conjunctiva are delicate and can rupture from minimal stress or for no apparent reason.

Risk Factors

While anyone can develop a subconjunctival hemorrhage, certain factors increase the likelihood:

Diagnosis

Subconjunctival hemorrhage is typically diagnosed through visual examination. No special tests are usually needed unless there are concerning features or recurrent episodes.

Diagnostic Approach

• Visual Inspection: The characteristic bright red patch is usually diagnostic
• Medical History: Questions about trauma, medications, and systemic conditions
• Blood Pressure Check: To rule out hypertension as a cause
• Eye Examination: To ensure no other eye problems are present

When Further Testing May Be Needed

• Recurrent subconjunctival hemorrhages
• Bleeding in other parts of the body
• Known bleeding disorder
• Associated pain or vision changes
• History of significant trauma

Additional Tests

If indicated, these tests may be performed:

• Blood tests to check clotting function
• Complete blood count
• Blood glucose levels
• Detailed eye examination with slit lamp

Treatment Options

Subconjunctival hemorrhage typically requires no treatment and resolves on its own. The body gradually reabsorbs the blood over 1-2 weeks.

Conservative Management

• Observation: Simply monitoring as the hemorrhage resolves
• Artificial Tears: To relieve any mild irritation or foreign body sensation
• Avoid Eye Rubbing: To prevent further irritation or bleeding

What Not to Do

• Don't use aspirin or NSAIDs unless prescribed for other conditions
• Avoid blood-thinning supplements during healing
• Don't use eye drops containing vasoconstrictors
• Avoid activities that increase eye pressure

Addressing Underlying Causes

• Blood pressure management if hypertensive
• Blood sugar control in diabetics
• Review of anticoagulant medications with physician
• Treatment of chronic cough or constipation

Timeline of Resolution

• Days 1-2: Hemorrhage may appear to spread as gravity affects the blood
• Days 3-5: Color begins to change from bright red to darker red
• Week 1: May turn yellowish as blood breaks down
• Week 2: Usually completely resolved

Prevention

While not all subconjunctival hemorrhages can be prevented, certain measures can reduce the risk:

• Control blood pressure through medication and lifestyle changes
• Manage diabetes effectively
• Avoid rubbing eyes vigorously
• Use protective eyewear during sports or hazardous activities
• Treat chronic cough or constipation to reduce straining
• Take blood-thinning medications as directed
• Use artificial tears if eyes are dry or irritated
• Avoid heavy lifting or straining when possible

When to See a Doctor

While most subconjunctival hemorrhages are harmless, certain situations warrant medical attention:

Schedule an appointment if:

• Recurrent subconjunctival hemorrhages
• Hemorrhage doesn't improve after 2 weeks
• You have a bleeding disorder
• You're on blood thinners
• Unexplained bruising elsewhere on the body
• High blood pressure concerns

Related Conditions

Frequently Asked Questions