What to do if a subconjunctival (under the conjunctiva) hemorrhage gets larger?

Management of Enlarging Subconjunctival Hemorrhage

If a subconjunctival hemorrhage is getting larger, observation and reassurance are the most appropriate management strategies, as most cases will resolve spontaneously without intervention within 1-2 weeks.

Clinical Assessment

When a subconjunctival hemorrhage is enlarging, it's important to:

• Evaluate the extent and progression of the hemorrhage
• Check for any associated symptoms (pain, vision changes, discharge)
• Assess for potential underlying causes:
  • Recent trauma or eye surgery
  • Hypertension (particularly in older patients) 1
  • Anticoagulant use 2
  • Bleeding disorders 3
  • Acute conjunctivitis 1
  • Valsalva maneuvers (coughing, vomiting, straining)

Management Approach

First-line Management

• Observation: Most subconjunctival hemorrhages are benign and self-limiting 4
• Reassurance: Explain to the patient that:
  • The condition typically resolves without treatment in 1-2 weeks
  • Vision is not affected
  • No specific treatment is needed for the hemorrhage itself

Supportive Care

• Artificial tears for any associated irritation or foreign body sensation
• Cold compresses may provide symptomatic relief
• Avoid rubbing the eyes to prevent further bleeding

When to Consider Further Evaluation

• If the hemorrhage is:
  • Recurrent or persistent
  • Associated with vision changes
  • Accompanied by pain
  • Occurring bilaterally
  • Extremely large or rapidly expanding

Special Considerations

Potential Red Flags

• Recurrent bilateral hemorrhages may indicate systemic disease 3
• Extremely low platelet count can present initially as subconjunctival hemorrhage 5
• Patients on anticoagulation therapy may experience more severe or recurrent hemorrhages 2

Blood Pressure Evaluation

• Blood pressure should be checked in patients with subconjunctival hemorrhage, particularly in older adults 1
• Hypertension is a common underlying cause in elderly patients

Follow-up Recommendations

• Most cases do not require follow-up if asymptomatic
• Return visit in 1-2 weeks if the hemorrhage continues to enlarge
• Immediate return if vision changes, severe pain develops, or signs of infection appear

Conclusion

Subconjunctival hemorrhage, even when enlarging, typically requires no specific intervention beyond observation and reassurance. The condition is benign and self-limiting in the vast majority of cases, with complete resolution occurring within 1-2 weeks.