Treatment for Subconjunctival Hemorrhage
Subconjunctival hemorrhage requires no specific treatment as it typically resolves spontaneously within 1-2 weeks without intervention. 1
Understanding Subconjunctival Hemorrhage
Subconjunctival hemorrhage is a common clinical presentation characterized by blood accumulation between the conjunctiva and sclera. While it appears alarming to patients due to its bright red appearance, it is generally benign and self-limiting.
Management Approach
Primary Treatment
- Observation: The mainstay of treatment is observation and reassurance, as most cases resolve spontaneously within 1-2 weeks
- Artificial tears: May be used if mild irritation is present
- Cold compresses: Can be applied in the first 24-48 hours to reduce discomfort
When to Consider Additional Evaluation
Additional evaluation should be considered in cases with:
- Recurrent or bilateral hemorrhages
- Severe or extensive bleeding
- Associated trauma
- Patients on anticoagulation therapy
- Systemic symptoms suggesting underlying disease
Special Considerations
Traumatic Subconjunctival Hemorrhage
- Requires thorough evaluation for associated ocular injuries
- Visual acuity assessment is crucial - reduced vision (< 20/40) significantly increases the probability of additional ocular damage 2
- Complete eye examination to rule out globe rupture or other injuries
Medication-Related Hemorrhage
- Patients on anticoagulants may experience more frequent or severe subconjunctival hemorrhages 3
- No need to discontinue anticoagulation therapy for isolated subconjunctival hemorrhage
- Consider consulting with the prescribing physician if hemorrhages are recurrent or extensive
Systemic Disease Considerations
- Recurrent spontaneous subconjunctival hemorrhages may indicate underlying systemic disorders such as:
- Hypertension
- Blood dyscrasias
- Thrombocytopenia
- Coagulopathies
- Complete blood count and coagulation studies may be warranted in recurrent cases 4
Patient Education
- Reassure patients about the benign nature and self-limiting course
- Explain that the blood will gradually change color (similar to a bruise) before completely resolving
- Advise against eye rubbing
- Instruct patients to return if:
- Vision changes occur
- Pain develops
- Hemorrhage doesn't resolve within 2-3 weeks
- New hemorrhages develop frequently
Prevention in High-Risk Settings
For patients undergoing procedures with high risk of subconjunctival hemorrhage (e.g., intravitreal injections):
- Topical oxymetazoline applied 30 minutes before the procedure can reduce the incidence of subconjunctival hemorrhage 5
Clinical Pitfalls to Avoid
- Overlooking trauma as a cause of subconjunctival hemorrhage
- Missing associated ocular injuries in traumatic cases
- Failing to investigate recurrent or bilateral hemorrhages
- Not considering systemic causes in spontaneous, recurrent cases
- Unnecessary treatment with antibiotics or other medications that provide no benefit
Remember that while most subconjunctival hemorrhages are benign, they can occasionally be the first presenting sign of a serious systemic condition such as idiopathic thrombocytopenic purpura or other blood disorders 4.