What is a subconjunctival hemorrhage?

The conjunctiva is a clear tissue that covers the white of the eye (the sclera) and lines the inside of both eyelids. A subconjunctival hemorrhage is blood that is located between the conjunctiva and the underlying sclera.

What causes a subconjunctival hemorrhage?

The conjunctiva contains nerves and many small blood vessels. These blood vessels are usually barely visible but become larger and more visible if the eye is inflamed. These blood vessels are somewhat fragile and their walls may break easily, resulting in a subconjunctival hemorrhage (bleeding under the conjunctiva). A subconjunctival hemorrhage appears as a bright red or dark red patch on the sclera. Most subconjunctival hemorrhages are spontaneous without an obvious cause for the bleeding from normal conjunctival blood vessels. Since most subconjunctival hemorrhages are painless, a person may discover a subconjunctival hemorrhage only by looking in the mirror. Many spontaneous subconjunctival hemorrhages are first noticed by another person seeing a red spot on the white of your eye. Rarely there may be an abnormally large or angulated blood vessel as the source of the hemorrhage.

The following can occasionally result in a spontaneous subconjunctival hemorrhage:

• Sneezing



• Coughing



• Straining/vomiting



• Increasing the pressure in the veins of the head, as in weight lifting



• Eye rubbing or inserting contact lenses



• Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacteria weaken the walls of small blood vessels under the conjunctiva



• Medical disorder causing bleeding or inhibiting normal clotting.

Subconjunctival hemorrhage can also be non-spontaneous and result from a severe eye infection, trauma to the head or eye or after eye or eyelid surgery.

What are symptoms and signs of a subconjunctival hemorrhage?

Most of the time, no symptoms are associated with a subconjunctival hemorrhage other than seeing blood over the white part of the eye.

• Very rarely people experience pain when the hemorrhage begins. When the bleeding first occurs, you may notice a sense of fullness in the eye or under the lid. As the hemorrhage resolves, some people may feel very mild irritation of the eye or merely a sense of awareness of the eye.



• The hemorrhage itself is an obvious, sharply outlined bright red area overlying the sclera. The entire white part of the eye may occasionally be covered by blood.



• In a spontaneous subconjunctival hemorrhage, no blood will exit from the eye. If you blot the eye with a tissue, there should be no blood on the tissue.



• The hemorrhage will appear larger within the first 24 hours after its onset and then will slowly decrease in size as the blood is absorbed.

Call your ophthalmologist (a medical doctor who specializes in eye care and surgery) if the subconjunctival hemorrhage does not get better within two weeks or if it has happened multiple times.

Also, call your ophthalmologist if you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with a new onset of easy bruising or bleeding gums.

Go to your ophthalmologist immediately if the subconjunctival hemorrhage is associated with

• pain,



• changes in vision (for example, blurry vision, double vision, difficulty seeing),



• a history of recent injury or trauma,



• a history of bleeding disorder, or



• a history of high blood pressure.

How is a subconjunctival hemorrhage diagnosed?

Your ophthalmologist will take a medical, eye, and medication history to determine what events were leading up to the subconjunctival hemorrhage and will also perform an examination. Your blood pressure may also be checked.

If trauma was the cause, a more thorough examination will usually be performed. Once the diagnosis of subconjunctival hemorrhage is made, your ophthalmologist might be able to tell you the cause and if there is any sign of damage to the eye.

In newborn infants, subconjunctival hemorrhage can occasionally be found as a result of the birth process. Shaken baby syndrome should be considered in young children with subconjunctival hemorrhages in both eyes.

What is the treatment for a subconjunctival hemorrhage?

Usually, no treatment is needed. Over-the-counter artificial tears can be applied to the eye if mild irritation is present. The eye does not require a patch.

The use of aspirin or other medication that inhibits clotting should be avoided. If you are taking aspirin or an anticoagulant for a medical condition, check with your physician to determine whether the medication should be stopped or continued.

If the subconjunctival hemorrhage is trauma-related, your ophthalmologist will determine what other treatment is necessary to promote healing of the injury.

If the subconjunctival hemorrhage is a result of an external infection, your ophthalmologist may prescribe antibiotic drops or an ointment.

This condition clears by itself within one to two weeks. Recovery is usually complete, without any long-term problems, similar to a mild bruise under the skin. Like a bruise, a subconjunctival hemorrhage changes colors (often red to orange to yellow) as it heals. A skin bruise changes to various shades of green, black, and blue as it heals, because the blood is being seen through skin. Because the conjunctiva is transparent, a subconjunctival hemorrhage never has these color characteristics.

Can a subconjunctival hemorrhage be prevented?

If you are having frequent subconjunctival hemorrhages or your subconjunctival hemorrhage is associated with easy bruising or bleeding elsewhere, you should have a medical evaluation for an underlying bleeding or clotting problem. Treatment of such an underlying condition may prevent future hemorrhages.

Subconjunctival Hemorrhage At A Glance

• The conjunctiva is the thin, moist, transparent membrane that covers the white part of the eye (called the sclera) and the inside of the eyelids. The conjunctiva is the outermost protective coating of the eyeball.
• The conjunctiva contains nerves and many small blood vessels. These blood vessels are usually barely visible but become larger and more visible if the eye is inflamed. These blood vessels are somewhat fragile and their walls may break easily, resulting in a subconjunctival hemorrhage (bleeding under the conjunctiva). A subconjunctival hemorrhage appears as a bright red or dark red patch on the sclera.

REFERENCE:

Fukuyama, J., Hayasaka, S., Yamada, K., Setogawa, T. "Causes of Subconjunctival Hemorrhage." Ophthalmologica 200 (1990): 63-67.

Last Editorial Review: 10/22/2009 12:10:06 PM

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