Treatment of Subconjunctival Hemorrhage
Subconjunctival hemorrhage typically requires no specific treatment and will resolve spontaneously within 1-2 weeks without intervention. 1
What is a Subconjunctival Hemorrhage?
A subconjunctival hemorrhage is bleeding underneath the conjunctiva, appearing as a bright red patch on the white of the eye. It occurs when small blood vessels break beneath the conjunctiva, causing blood to be trapped.
Management Approach
First-Line Management
- Observation and reassurance - Most cases resolve spontaneously within 1-2 weeks without treatment 1, 2
- Artificial tears - May provide comfort if mild irritation is present
- Cold compresses - Can be applied to reduce minor discomfort in the first 24 hours
When to Consider Additional Evaluation
Evaluation for underlying causes should be considered in these scenarios:
- Recurrent or bilateral subconjunctival hemorrhages
- Severe or extensive hemorrhages
- Hemorrhages associated with systemic symptoms
- Patients on anticoagulation therapy 3
- Patients with known bleeding disorders
Risk Factors to Assess
Common Risk Factors
- Younger patients: Trauma and contact lens usage 2
- Elderly patients: Systemic vascular diseases (hypertension, diabetes, arteriosclerosis) 2
- Other factors:
- Sudden increases in intrathoracic pressure (coughing, sneezing, vomiting, heavy lifting)
- Anticoagulant or antiplatelet medications 3
Uncommon but Important Risk Factors
- Bleeding disorders (though prevalence is <1% in patients with SCH) 4
- Severe hypertension
- Conjunctival malignancies
Special Considerations
Anticoagulation Therapy
- Patients on anticoagulants may experience more extensive or recurrent hemorrhages 3
- Generally, anticoagulation should not be discontinued solely due to subconjunctival hemorrhage
- If hemorrhages are severe or recurrent, consider evaluation of anticoagulation levels
Recurrent Subconjunctival Hemorrhages
- Evaluate for systemic hypertension
- Consider screening for bleeding disorders, though studies suggest limited yield 4
- Assess medication side effects
- Consider evaluation for systemic and ocular malignancies 2
Patient Education
Patients should be informed that:
- The condition looks alarming but is typically benign
- Complete resolution usually occurs within 1-2 weeks
- The red area may change color (like a bruise) before clearing
- No eye drops or medications are typically needed
- Return for evaluation if:
- The hemorrhage doesn't resolve within 2-3 weeks
- Visual changes occur
- Pain develops
- Recurrent episodes occur
Pitfalls to Avoid
- Unnecessary antibiotic treatment - Subconjunctival hemorrhage is not an infection and does not require antibiotics
- Corticosteroid use - Not indicated and may delay healing
- Missing underlying systemic conditions in cases of recurrent hemorrhages
- Failure to recognize rare but serious causes of subconjunctival hemorrhage such as blood dyscrasias 5
While recent research has investigated potential associations between subconjunctival hemorrhage and acute coronary syndrome, current evidence does not support a significant association between these conditions 6.