What is the treatment for conjunctival bleeding?

Treatment for Conjunctival Bleeding

For subconjunctival hemorrhage, the most effective treatment is typically observation and reassurance as most cases resolve spontaneously within 1-2 weeks without intervention. 1

Types of Conjunctival Bleeding

Subconjunctival Hemorrhage

• Presentation: Sudden, painless bright red blood under the clear conjunctiva 2
• Common causes:
  • In younger patients: trauma and contact lens usage 1
  • In elderly: systemic vascular diseases (hypertension, diabetes, arteriosclerosis) 1
  • In children: trauma (83%) and ocular surface inflammation (13%) 3

Inflammatory Conjunctival Bleeding

• Associated with various forms of conjunctivitis
• May require specific treatment based on underlying cause

Treatment Algorithm

1. Subconjunctival Hemorrhage (Most Common)

• First-line approach: Observation and reassurance
• Patient education:
  • Explain benign nature and spontaneous resolution within 1-2 weeks
  • Avoid rubbing eyes
  • Consider artificial tears for comfort if mild irritation present

2. Bacterial Conjunctivitis with Bleeding

• First-line treatment: 5-7 day course of broad-spectrum topical antibiotic 4
  • Moxifloxacin 0.5% ophthalmic solution three times daily for 7 days 4, 5
  • Alternative options include other fluoroquinolones or aminoglycosides

3. Viral Conjunctivitis with Bleeding

• Treatment: Supportive care with lubricants
• For subepithelial infiltrates: Consider topical corticosteroids at minimum effective dose if vision affected 6
• For herpes simplex virus: Topical ganciclovir 0.15% gel three to five times per day or trifluridine 1% solution five to eight times per day 6

4. Severe Inflammatory Conditions

• For medication-induced/preservative-induced keratoconjunctivitis:

  • Discontinue offending agent
  • Consider brief course of preservative-free topical corticosteroids for severe inflammation 6

• For ocular mucous membrane pemphigoid:

  • Topical corticosteroids for acute inflammation
  • Systemic immunosuppressive therapy for long-term management 6

Special Considerations

When to Refer to Ophthalmology

• Recurrent or persistent subconjunctival hemorrhage
• Visual loss
• Moderate to severe pain
• Severe purulent discharge
• Corneal involvement
• Conjunctival scarring
• Lack of response to therapy after 3-4 days 4

Workup for Recurrent Cases

• Evaluate for:
  • Systemic hypertension
  • Bleeding disorders (though prevalence is <1%) 7
  • Systemic and ocular malignancies
  • Drug side effects 1

Prevention Measures

• Frequent handwashing
• Avoid sharing towels and pillowcases
• Change pillowcases frequently during infection
• Avoid touching or rubbing eyes 4
• For contact lens wearers: appropriate lens care and frequent replacement 4

Common Pitfalls to Avoid

• Overuse of antibiotics for viral conjunctivitis
• Prolonged use of corticosteroids without ophthalmology supervision
• Failure to recognize potentially serious causes of conjunctivitis
• Inadequate hygiene education
• Delayed referral for severe or non-responsive cases 4