What are the recommended eye drops for subconjunctival hemorrhage?

Management of Subconjunctival Hemorrhage

For subconjunctival hemorrhage, observation and artificial tear lubricants are the recommended treatment approach, as this is typically a self-limiting condition that resolves without specific intervention within 1-2 weeks.

Understanding Subconjunctival Hemorrhage

Subconjunctival hemorrhage (SCH) is a common, benign condition characterized by the sudden appearance of painless bright red blood under the clear conjunctiva, often occurring during sleep 1. It results from the rupture of small blood vessels in the conjunctiva, causing blood to collect between the conjunctiva and sclera.

Key Characteristics:

• Painless bright red appearance
• No visual impairment
• Self-limiting condition
• Usually resolves within 1-2 weeks without treatment

Treatment Approach

First-Line Management:

1. Observation: Most cases resolve spontaneously within 1-2 weeks without specific treatment
2. Artificial tear lubricants:
   • Polyvinyl alcohol eye drops: Instill 1-2 drops in the affected eye(s) as needed 2
   • Sodium carboxymethylcellulose eye drops: Instill 1-2 drops in the affected eye(s) as needed 3

When to Consider Additional Evaluation:

Recurrent or persistent subconjunctival hemorrhages warrant further evaluation for:

• Systemic hypertension
• Bleeding disorders
• Systemic and ocular malignancies
• Medication side effects (especially anticoagulants) 4

Risk Factors

Age-Related Risk Factors:

• Younger patients: Trauma and contact lens usage 4
• Elderly patients: Systemic vascular diseases (hypertension, diabetes, arteriosclerosis) 4

Distribution Patterns:

• Overall, SCH is more common in inferior areas than superior areas (55.3% vs. 25.0%) 5
• Traumatic SCH typically appears as localized hemorrhage in the temporal areas 5
• The extent of SCH shows an age-related increase 5

Special Considerations

Potential Systemic Associations:

While SCH is generally benign, it can occasionally be the presenting sign of serious underlying conditions:

• In rare cases, it may be the first presenting clinical feature of idiopathic thrombocytopenic purpura 6
• Patients with diabetes mellitus, hypertension, and those taking aspirin have higher risk factors for vascular events, though a large population-based study found no significant association between SCH and acute coronary syndrome 7

Common Pitfalls to Avoid:

1. Overtreatment: Avoid unnecessary medications like antibiotics or steroids, as they provide no benefit for uncomplicated SCH
2. Missing underlying causes: In recurrent cases, failure to investigate potential systemic causes
3. Causing unnecessary patient anxiety: Reassurance about the benign and self-limiting nature of most cases is essential

Remember that while most cases of subconjunctival hemorrhage are benign and self-limiting, recurrent episodes should prompt a thorough investigation for underlying systemic conditions.