What is the treatment for a subconjunctival (under the conjunctiva) hematoma?

Management of Subconjunctival Hemorrhage

Subconjunctival hemorrhages typically require no specific treatment and will resolve spontaneously within 1-2 weeks without intervention. 1

Clinical Presentation

• Appears as a bright red patch on the white of the eye (sclera)
• Usually painless, though may cause mild irritation
• No visual changes
• May be localized or diffuse, unilateral or bilateral

Treatment Approach

First-Line Management

• Observation and reassurance
  • Most cases resolve spontaneously within 1-2 weeks 1
  • No medical intervention required for typical cases
• Artificial tears for comfort if mild irritation is present 1
• Patient education about benign nature and expected resolution

When to Consider Further Evaluation

Further workup is warranted in the following scenarios:

• Recurrent or bilateral subconjunctival hemorrhages
• Extensive or severe hemorrhages
• Associated systemic symptoms
• Failure to resolve within 2-3 weeks
• Development of pain or visual changes

Special Considerations

Risk Factors Requiring Attention

• Trauma and contact lens usage in younger patients 2
• Systemic vascular diseases in elderly patients:
  • Hypertension
  • Diabetes
  • Arteriosclerosis 2

Warning Signs for Serious Underlying Conditions

• Massive or bilateral spontaneous subconjunctival hemorrhage may indicate blood dyscrasias 3
• Recurrent episodes may suggest:
  • Bleeding disorders (e.g., idiopathic thrombocytopenic purpura) 4
  • Systemic hypertension
  • Ocular or systemic malignancies
  • Medication side effects (especially anticoagulants) 2

Patient Education Points

• Reassure that the condition looks more alarming than it is
• Explain that the red area may change color (like a bruise) before clearing
• Advise that complete resolution typically occurs within 1-2 weeks
• Instruct to return if:
  • Hemorrhage doesn't resolve within 2-3 weeks
  • Visual changes occur
  • Pain develops
  • Recurrent episodes occur 1

Conclusion

For the vast majority of patients with subconjunctival hemorrhage, simple observation and reassurance are all that is needed, as the condition will resolve spontaneously. Only in cases with concerning features (recurrence, bilaterality, extensive bleeding, or associated symptoms) is further workup indicated to rule out underlying systemic conditions.