Do subconjunctival hemorrhages get bigger?

Subconjunctival Hemorrhages: Natural Progression and Management

Subconjunctival hemorrhages typically do not get bigger after their initial presentation and will gradually resolve over 1-2 weeks without treatment. 1

What is a Subconjunctival Hemorrhage?

A subconjunctival hemorrhage is a benign condition characterized by bleeding under the conjunctiva, appearing as a bright red patch on the white of the eye. It occurs when small blood vessels in the conjunctiva rupture.

Natural History and Progression

Subconjunctival hemorrhages have a predictable course:

• They appear suddenly, reaching their full size at onset
• They do not typically enlarge after initial presentation
• The bright red appearance gradually changes to orange-yellow as the blood is absorbed
• Complete resolution usually occurs within 1-2 weeks 1
• The hemorrhage resolves without treatment and without permanent damage to the eye

Risk Factors and Causes

Common causes of subconjunctival hemorrhages include:

• Trauma: Minor eye trauma or eye rubbing 2
• Contact lens use: Particularly with improper insertion or removal 2
• Valsalva maneuvers: Coughing, sneezing, vomiting, or straining 1
• Systemic conditions: Hypertension, diabetes, and arteriosclerosis (especially in elderly patients) 2
• Medications: Anticoagulants and blood thinners 3
• Viral conjunctivitis: Can cause petechial and subconjunctival hemorrhages 1

When to Be Concerned

While most subconjunctival hemorrhages are benign and self-limiting, certain situations warrant further investigation:

• Recurrent or persistent hemorrhages: May indicate underlying systemic conditions 2
• Bilateral and severe hemorrhages: Could suggest blood disorders or clotting abnormalities 3
• Associated with other symptoms: Such as vision changes, pain, or discharge
• History of bleeding disorders: May require hematologic evaluation 4

Rare but Serious Causes

In rare cases, recurrent subconjunctival hemorrhages may be associated with:

• Blood dyscrasias: Such as idiopathic thrombocytopenic purpura 4
• Vascular malformations: Conjunctival cavernous hemangiomas can cause recurrent hemorrhages 5
• Malignancies: Rarely, ocular or systemic malignancies may present with subconjunctival hemorrhage 2

Management Approach

1. Reassurance: Explain the benign nature and self-limiting course
2. Observation: No specific treatment is needed for isolated subconjunctival hemorrhages
3. Lubricating eye drops: May provide comfort if mild irritation is present
4. Avoid eye rubbing: To prevent recurrence
5. Blood pressure check: Especially in older patients or those with risk factors

When to Seek Medical Attention

Advise patients to seek medical attention if:

• The hemorrhage doesn't resolve within 2-3 weeks
• Recurrent episodes occur
• Vision changes develop
• Pain or significant discomfort occurs
• The hemorrhage is associated with trauma
• The patient is on anticoagulant therapy

Conclusion

Subconjunctival hemorrhages are benign, self-limiting conditions that typically do not enlarge after their initial presentation. They resolve spontaneously within 1-2 weeks without treatment or complications. While most cases are harmless, recurrent or persistent hemorrhages should prompt investigation for underlying systemic conditions.