Definition

Subconjunctival hemorrhage is a condition characterized by eye redness caused by ruptured ocular blood vessels. Although it may appear alarming, subconjunctival hemorrhage typically does not pose further danger.

The conjunctiva is a clear layer that covers the sclera (white part of the eye) and the inner eyelid. It contains numerous blood vessels that provide nutrition to the cornea. When these vessels rupture, bleeding occurs, known as subconjunctival hemorrhage. This hemorrhage is not in the cornea, which is crucial for vision, so it does not cause blurry vision. Subconjunctival hemorrhage can be likened to a bruise on the skin. The conjunctiva cannot quickly absorb the blood, so the bleeding can persist for several days.

Causes

Subconjunctival hemorrhage can be caused by:

• Rubbing your eyes too hard
• Strong coughing or sneezing
• Straining (e.g., during bowel movements)
• Vomiting
• Surgical procedures
• Contact lenses usage
• Taking blood thinning medications (e.g., aspirin, warfarin) or currently on cancer treatments (e.g., interferon)
• Strenuous activities such as lifting weights
• Blunt trauma to the eye

Risk Factor

Several conditions can increase the risk of subconjunctival hemorrhage, including high blood pressure, diabetes, lung diseases causing persistent coughing (e.g., TB, COPD), and blood clotting disorders. While subconjunctival hemorrhage can occur at any age, it is more common in older adults.

Symptoms

Typically, individuals do not realize they have a subconjunctival hemorrhage until they look in a mirror, as there are usually no specific symptoms like watery eyes, pain, or itching on the eyes. The primary sign is a reddish spot on the sclera, which is not accompanied by decreased vision, blurred vision, or eye discharge.

Diagnosis

A diagnosis of subconjunctival hemorrhage can be established through a medical interview and physical examination. The doctors will ask about recent activities, medications, presence of blurred vision, and any recent blunt trauma to the eye, occurring from blunt objects or getting hit. Blood pressure will also be checked, and a slit lamp examination will be used to closely inspect the eye. Blood tests may be ordered if a blood disorder is suspected.

Management

Subconjunctival bleeding typically resolves on its own within two weeks. If pain or swelling is present, cold compresses and artificial tears can provide relief. If the hemorrhage is related to an underlying condition, such as high blood pressure or chronic cough, the doctor will treat the primary condition.

Complications

Generally, subconjunctival hemorrhage does not lead to further complications. However, in older individuals, it can be an indicator of more serious vascular diseases.

Prevention

To prevent subconjunctival hemorrhage, you can:

• Rub your eyes, but do it gently
• Disinfect and clean contact lenses regularly
• Use eye protection in activities such as exercising, that could cause eye trauma
• Maintain regular treatment for any underlying health conditions

When to See a Doctor?

You should consult a doctor if you experience subconjunctival hemorrhage more than twice in one year, do not see improvement of symptoms within two weeks, and you have accompanying symptoms such as bleeding gums and nosebleeds

Immediate medical attention is necessary if the subconjunctival hemorrhage occurs after blunt trauma (e.g., being hit by a ball, head injury, fall, accident) with or without symptoms like blurred vision, double vision, sudden dark vision, severe pain, watery eyes, swollen eyes, or blood pooling in the eye, as these may indicate a more serious condition, such as hyphema.

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