Definition and Overview

Bleeding from or in the eye, medically known as ocular hemorrhage, can occur in various locations and have different implications. The most common and usually harmless type is a bright red patch on the white of the eye (subconjunctival hemorrhage). However, bleeding can also occur inside the eye chambers, behind the retina, or from the eye surface, each with different causes and levels of concern.

Understanding the location of bleeding is crucial. External bleeding visible on the eye surface is often less serious than internal bleeding within the eye structures. Internal bleeding may not be immediately visible but can cause vision changes, eye pain, or other symptoms. The appearance, location, and associated symptoms help determine the urgency of medical evaluation.

While many cases of eye bleeding resolve without treatment, some types indicate serious conditions requiring immediate medical attention. Bleeding inside the eye can lead to permanent vision loss if not promptly treated, making it essential to recognize warning signs and seek appropriate care.

Types and Causes of Eye Bleeding

External/Visible Bleeding

  • Subconjunctival hemorrhage: Blood under conjunctiva
  • Causes: Coughing, sneezing, straining
  • Eye trauma: Direct injury to eye
  • Blood thinners: Aspirin, warfarin
  • High blood pressure: Vessel rupture
  • Violent vomiting: Pressure increase
  • Eye rubbing: Aggressive rubbing
  • Contact lens injury: Improper use

Internal Eye Bleeding

  • Hyphema: Blood in front chamber
  • Vitreous hemorrhage: Blood in gel-filled center
  • Retinal hemorrhage: Bleeding in retina
  • Diabetic retinopathy: Diabetes complication
  • Macular degeneration: Age-related
  • Retinal tear/detachment: Emergency condition
  • Posterior vitreous detachment: Age-related
  • Eye tumors: Rare but serious

Systemic and Other Causes

  • Blood disorders: Clotting problems
  • Leukemia: Blood cancer
  • Severe anemia: Low blood counts
  • Head trauma: Shaken baby syndrome
  • Birth trauma: Newborn bleeding
  • Eye surgery complications: Post-operative
  • Severe hypertension: Malignant high BP
  • Blood vessel malformations: Abnormal vessels

Associated Signs and Symptoms

Visual Symptoms

  • Vision loss or blurriness
  • Floaters or spots
  • Flashing lights
  • Dark curtain over vision
  • Distorted vision
  • Light sensitivity
  • Seeing halos
  • Complete vision blackout

Other Symptoms

  • Eye pain
  • Headache
  • Eye pressure sensation
  • Nausea or vomiting
  • Eye discharge
  • Swollen eyelids
  • Double vision
  • Eye movement problems

When to Seek Emergency Care

Seek immediate medical attention for:

  • Any vision loss or changes
  • Eye pain with bleeding
  • Bleeding after eye injury
  • Blood inside the eye (not just on surface)
  • Bleeding with severe headache
  • Recurrent eye bleeding
  • Bleeding in both eyes
  • Eye bleeding with bruising elsewhere
  • Bleeding after eye surgery
  • Associated neurological symptoms
  • Bleeding with high fever
  • Known bleeding disorder with eye bleeding

Important: Internal eye bleeding is a medical emergency that can lead to permanent vision loss.

Diagnostic Approach

Eye specialists evaluate bleeding through:

Examination Methods

  • Visual acuity test: Check vision clarity
  • Slit lamp examination: Detailed eye inspection
  • Ophthalmoscopy: View inside eye
  • Tonometry: Eye pressure measurement
  • Ultrasound: If view obscured
  • Fluorescein angiography: Blood vessel imaging
  • OCT scan: Retinal imaging
  • Blood tests: Clotting studies

Treatment and Management

Minor Bleeding Care

  • Usually no treatment needed
  • Avoid rubbing eyes
  • Artificial tears for comfort
  • Avoid blood thinners if possible
  • Monitor for changes
  • Rest and avoid strain
  • Control blood pressure
  • Follow up if not improving

Medical Treatments

  • Eye drops for pressure
  • Laser treatment for vessel leaks
  • Vitrectomy for severe bleeding
  • Injections for macular degeneration
  • Surgery for retinal detachment
  • Treatment of underlying conditions
  • Blood pressure management
  • Diabetes control

Prevention

Reduce your risk of eye bleeding:

  • Eye protection: Wear safety glasses when needed
  • Manage health conditions: Control diabetes, BP
  • Regular eye exams: Early detection
  • Avoid eye rubbing: Gentle eye care
  • Proper contact lens care: Follow guidelines
  • Control coughing/sneezing: Reduce pressure
  • Medication review: Discuss blood thinners
  • Treat infections promptly: Prevent complications
  • Healthy lifestyle: Exercise, diet
  • Avoid straining: During bowel movements