Subconjunctival Hemorrhage

What is a subconjunctival hemorrhage?

A subconjunctival hemorrhage is when a blood vessel breaks open in the white of the eye. It causes a bright red patch in the white of the eye. It is similar to a bruise on the skin.

The conjunctiva is the thin layer that covers the inside of the eyelids and the surface of the eye. It contains many tiny blood vessels that bring oxygen and nutrients to the eye. The sclera is the white part of the eye that lies beneath the conjunctiva. Sometimes, a blood vessel in the conjunctiva breaks open and bleeds. The blood then collects underneath the conjunctiva and turns part of the eye red. Over several weeks, your body then removes the released blood.

A subconjunctival hemorrhage can look quite alarming. But they are usually harmless, and they are common. They can happen to people of any age. Older adults have them more often.

What causes subconjunctival hemorrhage?

In many cases, the cause of the condition is not known. But some health conditions may increase the risk. These include:

• Eye trauma (including trauma from eye surgery)
• High blood pressure
• Inflammation of the conjunctiva
• Contact lens use
• Diabetes
• Arteriosclerosis
• Tumor of the conjunctiva
• Diseases that impair blood clotting
• Violent sneezing, coughing, or vomiting
• Certain medicines that can increase bleeding, like aspirin
• Pushing hard during delivery of newborns
• Straining because of constipation

Some of these causes, like eye trauma and contact lens use, are more common in young adults. Others, like high blood pressure and diabetes, are more common in older adults.

What are the symptoms of subconjunctival hemorrhage?

Other than a red eye, you probably won’t have any symptoms. You might feel like you have something in your eye, but this is not common. The hemorrhage shouldn’t impair your vision, and it shouldn’t cause any pain. If you do have pain, you may have another type of problem with your eye.

Some people notice a red eye after some sort of eye trauma. Other people might notice their hemorrhage without any trauma. They may notice it after waking up in the morning.

In most cases, just one eye will have a hemorrhage. It typically happens once and then goes away. But some medical conditions might cause repeated hemorrhages.

How is subconjunctival hemorrhage diagnosed?

Your healthcare provider will ask about your medical history. You may have a physical exam. This includes a basic eye exam. A primary healthcare provider will often make the diagnosis. He or she will rule out other causes of red eye that might need other treatment.

Your primary care provider might send you to an eye healthcare provider (ophthalmologist) if he or she thinks you may have a different problem with your eye. You will need to see an ophthalmologist if you have had an eye injury. This eye healthcare provider might use a special lighted microscope to look at your eye in more detail. This helps show the eye healthcare provider if the injury hurt the eye itself and not just its outer layer.

If this is your first subconjunctival hemorrhage, your healthcare provider may not give you more tests. If you have had more than one, your healthcare provider may need to find the cause. For example, you may need blood tests to check for a blood clotting disorder.

How is subconjunctival hemorrhage treated?

Most people with subconjunctival hemorrhage will not need any treatment. These hemorrhages usually go away on their own. Your subconjunctival hemorrhage will probably go away within a few weeks, first turning from red, to brown, to yellow. Currently, there are no treatments that will speed up this process. Your healthcare provider may suggest warm compresses and eye drops (“artificial tears”) to help relieve a little of the redness.

Your healthcare provider will mainly focus on treating any underlying disorders that might have caused your subconjunctival hemorrhage, if present. For example, you might need a blood pressure medicine if high blood pressure contributed to your subconjunctival hemorrhage.

Can subconjunctival hemorrhage be prevented?

In most cases, a subconjunctival hemorrhage is not preventable. Seeking regular treatment for your other medical conditions may help prevent some cases of a subconjunctival hemorrhage.

When should I call my healthcare provider?

Call your healthcare provider if your subconjunctival hemorrhage does not go away in 2 to 3 weeks. Also, call your healthcare provider if you have pain in the eye or vision loss.

If you have a history of eye trauma or repeated hemorrhages, get your eye evaluated. An eye care professional needs to examine your eye and rule out more dangerous causes. You may also need to see your regular health practitioner to rule out other problems, such as high blood pressure or a bleeding disorder.

Key points about subconjunctival hemorrhage

A subconjunctival hemorrhage happens when a blood vessel of the conjunctiva breaks open. This causes a bright red patch in the white of the eye. Subconjunctival hemorrhages may look alarming, but they are generally harmless:

• Sometimes, a subconjunctival hemorrhage can happen without any known cause. Some medical conditions can cause a subconjunctival hemorrhage as well.
• Your healthcare provider will need to rule out other, more serious causes of your red eye. You might need to see an ophthalmologist.
• Most times a subconjunctival hemorrhage will go away without any treatment.
• Your subconjunctival hemorrhage should go away in a couple of weeks. See your healthcare provider if this doesn’t happen, or if you have repeated subconjunctival hemorrhages.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.