Treatment for Subconjunctival Hemorrhage
Subconjunctival hemorrhage typically requires no specific treatment and will resolve spontaneously within 1-2 weeks without intervention. 1
Understanding Subconjunctival Hemorrhage
Subconjunctival hemorrhage is a benign condition characterized by bleeding under the conjunctiva, causing a bright red appearance on the white of the eye. It occurs when small blood vessels in the conjunctiva break, allowing blood to accumulate between the conjunctiva and sclera.
Treatment Algorithm
First-Line Management
- Observation and reassurance - Most cases resolve spontaneously within 1-2 weeks
- Artificial tears - May provide comfort if mild irritation is present
- Cold compresses - Can be applied during the first 24-48 hours to reduce discomfort
For Symptomatic Relief (if needed)
- Lubricating eye drops for any foreign body sensation
- Avoid rubbing the affected eye
- Discontinue contact lens wear until resolved
When to Investigate Further
Investigation is warranted when subconjunctival hemorrhage is:
- Recurrent or persistent
- Bilateral and severe
- Associated with other symptoms
Risk Factors to Assess
Common Risk Factors
- Trauma - Most common cause in younger patients 2
- Contact lens usage - Particularly with improper insertion/removal 2
- Valsalva maneuvers - Coughing, sneezing, vomiting, heavy lifting
- Systemic vascular diseases - Hypertension, diabetes, arteriosclerosis (more common in elderly) 2
Less Common but Important Risk Factors
- Anticoagulation therapy - May cause more severe or recurrent hemorrhages 3
- Blood disorders - Thrombocytopenia, von Willebrand disease, leukemia 4, 5
- Conjunctival malignancies - Rare but important to rule out in persistent cases
Special Considerations
Anticoagulation
- Patients on anticoagulants who develop subconjunctival hemorrhage do not typically require discontinuation of therapy 1
- Consultation with the prescribing physician may be warranted for recurrent cases
Warning Signs Requiring Urgent Evaluation
- Subconjunctival hemorrhage accompanied by:
- Significant eye pain
- Vision changes
- History of recent eye surgery
- Signs of infection
- Bleeding from other sites
Follow-up Recommendations
- Most isolated cases require no follow-up
- For recurrent cases, evaluate for:
- Uncontrolled hypertension
- Bleeding disorders
- Medication side effects
- Systemic or ocular malignancies 2
While some studies have investigated the relationship between hemostatic abnormalities and spontaneous recurrent subconjunctival hemorrhage, research suggests that routine hemostatic screening is not beneficial in patients without other systemic risk factors 6.