Treatment of Subconjunctival Hemorrhage
Subconjunctival hemorrhages typically require no specific treatment and resolve spontaneously within 2-3 weeks without intervention. 1
Primary Management Approach
First-Line Treatment
- Observation and reassurance
Symptomatic Relief (if discomfort present)
- Preservative-free artificial tears (hialuronato or carmelosa) to alleviate any associated discomfort 1
- Avoid eye rubbing to prevent further irritation or recurrence 1
Special Considerations
When Additional Evaluation is Needed
- Recurrent or persistent subconjunctival hemorrhages
- Bilateral or severe hemorrhages
- Associated with systemic symptoms
- Occurs in patients on anticoagulation therapy
Risk Factors That May Require Further Assessment
- Younger patients: trauma and contact lens usage 2
- Elderly patients: hypertension, diabetes, and arteriosclerosis 2
- Medication-related: anticoagulant therapy (may cause recurrent or severe hemorrhages) 3
- Systemic conditions: blood dyscrasias, clotting disorders, increased intrathoracic pressure from coughing/vomiting 3
When to Refer or Seek Additional Care
- Hemorrhage not resolving within 2-3 weeks
- Persistent ocular pain
- Vision changes
- Recurrent episodes 1
What NOT to Do
- Avoid unnecessary antibiotics in simple subconjunctival hemorrhages without signs of infection 1
- Do not apply pressure or attempt to "drain" the hemorrhage
Patient Education Points
- Blood may shift position under the conjunctiva before complete resolution
- The bright red appearance will gradually fade to yellow/green before clearing
- Condition is benign in most cases but may be a sign of underlying systemic disease if recurrent
Rare but Important Considerations
In rare cases, subconjunctival hemorrhage can be the first presenting sign of serious systemic conditions like idiopathic thrombocytopenic purpura, which requires prompt investigation and management 4.
Remember that while alarming in appearance, isolated subconjunctival hemorrhages are typically benign and self-limiting conditions that require minimal intervention beyond reassurance and symptomatic relief.