Management of Subconjunctival Hemorrhage
A subconjunctival hemorrhage (broken blood vessel in the eye) is a benign, self-limiting condition that typically resolves without treatment within 1-2 weeks and requires no medical intervention in most cases.
What Is a Subconjunctival Hemorrhage?
A subconjunctival hemorrhage occurs when a small blood vessel breaks under the conjunctiva (the clear membrane covering the white of the eye), causing a bright red patch to appear. This condition:
- Appears suddenly and painlessly, often noticed upon waking 1
- Looks alarming but is typically harmless
- Does not affect vision
- Does not require treatment in most cases
Assessment and Management
Immediate Management
- No treatment is necessary for an uncomplicated subconjunctival hemorrhage
- Artificial tears may be used for any mild irritation
- Cold compresses can help reduce minor discomfort if present
- Avoid rubbing the eye to prevent further bleeding
When to Seek Medical Attention
Medical evaluation is warranted if:
- The hemorrhage is recurrent or persistent
- The hemorrhage is accompanied by pain or vision changes
- There is a history of trauma
- You have a bleeding disorder or take blood thinners
- The hemorrhage is very large or doesn't improve within 2 weeks
Risk Factors
Age-Related Risk Factors
Younger patients (0-40 years):
- Trauma (77.7%)
- Contact lens use
- Unknown causes (22.3%) 2
Older patients (61-94 years):
- Hypertension (47.5%)
- Unknown causes (39.4%)
- Diabetes (13.1%) 2
Other Risk Factors
- Valsalva maneuvers (coughing, sneezing, heavy lifting)
- Eye rubbing
- Ocular surface disorders
- Anticoagulant medications
- Bleeding disorders
Special Considerations
Recurrent Subconjunctival Hemorrhages
Recurrent episodes may indicate underlying conditions requiring investigation:
- Systemic hypertension
- Bleeding disorders
- Diabetes
- Arteriosclerosis
- Medication side effects
- Rarely, systemic or ocular malignancies 3
In rare cases, recurrent subconjunctival hemorrhages may be the first presenting sign of serious conditions such as:
Follow-up
- Most cases resolve spontaneously within 1-2 weeks
- The red appearance gradually changes to yellow as it heals
- No specific follow-up is needed for isolated, non-recurrent episodes
- For recurrent episodes, follow-up with an ophthalmologist is recommended to rule out underlying conditions
Prevention
- Control hypertension and diabetes if present
- Avoid eye rubbing
- Use proper contact lens hygiene if applicable
- Consider protective eyewear during activities with risk of eye trauma
- Manage medications that may increase bleeding risk in consultation with your physician
Remember that while a subconjunctival hemorrhage looks alarming, it is typically harmless and will resolve on its own without treatment or complications.