Subconjunctival Hemorrhage: Causes and Treatments

Written by Medicover Team and Medically Reviewed by Dr Vompolu Kamakshi Bhaskar , Ophthalmologists

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

A subconjunctival hemorrhage occurs when a small blood vessel breaks just beneath the conjunctiva, the clear surface that covers the white part of the eye (sclera). Although it may appear serious, this condition is typically benign.

The conjunctiva contains numerous tiny blood vessels that can rupture, leading to a localized collection of blood. Despite its appearance, a subconjunctival hemorrhage usually does not cause pain or affect vision.

What Are the Types of Subconjunctival Hemorrhage?

Subconjunctival hemorrhage can be categorized based on its cause and frequency. Understanding the type can help determine whether further medical evaluation is necessary.

Spontaneous Hemorrhage: Occurs without any apparent cause, often associated with minor increases in blood pressure or minor eye strain.
Traumatic Hemorrhage: Directly results from physical trauma or injury to the eye.
Recurrent Hemorrhage: Multiple instances of hemorrhage, potentially indicating an underlying systemic issue such as hypertension or a bleeding disorder.

What Causes Subconjunctival Hemorrhage?

Subconjunctival hemorrhage occurs when tiny blood vessels beneath the clear surface of the eye break and bleed. It can happen due to minor irritation, sudden pressure changes, trauma, or underlying medical conditions.

Common Causes

Several factors can contribute to the rupture of blood vessels in the eye:

Trauma: Physical injury or trauma to the eye can lead to a subconjunctival hemorrhage. This includes rubbing the eye vigorously or an accidental impact.
Sudden Increases in Blood Pressure: Activities that cause a sudden spike in blood pressure, such as heavy lifting, coughing, sneezing, or vomiting, can cause blood vessels to burst.
Medical Conditions: Certain medical conditions, such as hypertension or diabetes, can weaken blood vessels, making them more susceptible to rupture.
Medications: Blood-thinning medications and anticoagulants can increase the likelihood of bleeding, including in the eyes.

Rare Causes

Less commonly, a subconjunctival hemorrhage may be associated with more serious conditions:

Blood Clotting Disorders: Conditions that affect blood clotting can increase the risk of hemorrhage.
Eye Surgery: Post-operative complications from eye surgery can sometimes result in a subconjunctival hemorrhage.
Infections: Severe eye infections, although rare, can lead to bleeding beneath the conjunctiva.

What Are the Symptoms of Subconjunctival Hemorrhage?

Subconjunctival Hemorrhage occurs when a small blood vessel breaks under the clear surface of the eye (conjunctiva). It often looks alarming but is usually harmless. Common symptoms include:

Bright red patch in the eye: A clearly visible red or blood-like spot on the white part (sclera).
No pain: Typically painless despite its dramatic appearance.
No vision changes: Vision usually remains normal.
Mild irritation (sometimes): Some people may feel slight discomfort or a scratchy sensation.
Sudden appearance: The red spot often appears suddenly without warning.
Color changes over time: The patch may turn yellow or green as it heals.

When Should You Seek Medical Attention for Subconjunctival Hemorrhage?

Medical attention from an ophthalmologist is important if subconjunctival hemorrhage occurs repeatedly, is associated with pain or vision changes, or does not improve over time. Early assessment can help identify underlying health concerns.

Recurrent Hemorrhages: Frequent occurrences may indicate an underlying health issue that needs to be addressed.
Associated Symptoms: If the hemorrhage is accompanied by pain, vision changes, or discharge, a more serious condition may be present.
Persistent Redness: If the red patch does not begin to fade after two weeks, or if it worsens, medical advice should be sought.

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How Is Subconjunctival Hemorrhage Diagnosed?

Diagnosis of a subconjunctival hemorrhage is generally straightforward and can be made through a visual examination by a healthcare professional. It is usually easy to diagnose and often does not require complex tests.

Physical eye examination: Doctors can identify it by simply looking at the eye; the red patch is clearly visible.
Slit-lamp examination: A detailed eye check using a special microscope to confirm the bleeding is limited to the conjunctiva.
Medical history review: Questions about recent coughing, sneezing, injury, or rubbing the eye.
Blood pressure check: To rule out high blood pressure as a cause.
Blood tests (if recurrent cases): To check for bleeding disorders or clotting problems.
Medication review: Doctors assess use of blood thinners or aspirin.

What Are the Treatment Options for Subconjunctival Hemorrhage?

Most cases heal naturally without specific treatment for Subconjunctival Hemorrhage, though supportive care may help relieve mild discomfort. Treatment of underlying conditions is important when recurrent bleeding occurs.

Observation and Time

In most cases, no specific treatment is required for a subconjunctival hemorrhage. The condition typically resolves on its own within one to two weeks. The blood is gradually absorbed by the body, and the red patch will fade.

Eye Drops and Lubricants

While treatment is often unnecessary, over-the-counter artificial tears or lubricating eye drops can provide comfort if there is mild irritation. These drops do not speed up healing but can help alleviate dryness and discomfort.

Medical Intervention

In rare instances where the hemorrhage is caused by an underlying condition, treating that condition is crucial. For example, managing hypertension or adjusting medications may be necessary. If an infection is present, appropriate antibiotic or antiviral treatments will be prescribed.

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How Can Subconjunctival Hemorrhage Be Prevented?

Preventive measures mainly focus on protecting the eyes and managing conditions that increase blood vessel fragility. Healthy habits and proper eye care can reduce the risk of recurrence.

Protecting the Eyes

Preventing trauma to the eyes is one of the most effective ways to reduce the risk of subconjunctival hemorrhage. This includes wearing protective eyewear during activities that pose a risk of injury.

Managing Health Conditions

Proper management of systemic conditions such as hypertension and diabetes is essential in preventing recurrent hemorrhages. Regular check-ups and adherence to prescribed treatments can help maintain overall vascular health.

Avoiding Strain

Avoiding activities that cause sudden increases in blood pressure can also help prevent hemorrhages. This includes practicing gentle techniques when lifting heavy objects and managing chronic coughing or sneezing through appropriate medical care.

What Are the Special Considerations for Subconjunctival Hemorrhage in Newborns?

Subconjunctival hemorrhage in newborns is usually related to pressure during childbirth and is generally harmless. The condition often resolves naturally without affecting vision.

Causes in Newborns

Subconjunctival hemorrhages can occur in newborns, typically as a result of the birthing process. The pressure exerted on the baby during delivery can cause small blood vessels in the eye to rupture. This condition is generally harmless and resolves without intervention.

Treatment and Monitoring

In newborns, a subconjunctival hemorrhage does not usually require treatment. However, it is important for healthcare providers to monitor the baby to ensure that there are no other associated complications. Parents should be reassured that the condition is temporary and does not affect the baby's vision.