What is the treatment for a subconjunctival hemorrhage?

Management of Subconjunctival Hemorrhage

Subconjunctival hemorrhage requires no specific treatment and will resolve spontaneously within 1-2 weeks without intervention. The condition is benign and self-limiting in most cases, with observation being the primary approach.

Clinical Presentation and Etiology

• Subconjunctival hemorrhage appears as a sudden, painless bright red blood patch under the clear conjunctiva
• Common causes include:
  • Trauma
  • Valsalva maneuver (coughing, sneezing, straining)
  • Contact lens usage (especially in younger patients)
  • Systemic vascular diseases (hypertension, diabetes, arteriosclerosis) in elderly patients 1
  • Spontaneous occurrence (often during sleep) 2

Assessment

When evaluating a patient with subconjunctival hemorrhage, consider:

• Location and extent of hemorrhage (inferior areas are more commonly affected than superior areas) 3
• Traumatic subconjunctival hemorrhages tend to be more localized and often appear in temporal areas 3
• Presence of associated symptoms (pain, discharge, vision changes)
• History of recurrence or persistence

Treatment Approach

1. Primary Management: Observation

   • Most subconjunctival hemorrhages resolve spontaneously within 1-2 weeks
   • No specific treatment is required for isolated, non-recurrent cases

2. Supportive Care

   • Artificial tears or lubricating eye drops may provide comfort if mild irritation is present
   • Cold compresses may help reduce any associated swelling in the first 24 hours

3. Patient Education

   • Reassure the patient about the benign nature of the condition
   • Explain that the blood will gradually absorb over 1-2 weeks, changing from bright red to yellow before clearing completely

When Further Evaluation is Warranted

Further investigation is necessary in cases of:

• Recurrent or persistent subconjunctival hemorrhages
• Hemorrhage associated with visual changes
• Concomitant bleeding from other sites
• History of bleeding disorders or anticoagulant use

Workup may include:

• Blood pressure measurement
• Complete blood count with platelet count
• Coagulation studies
• Evaluation for systemic and ocular malignancies 1

Special Considerations

• In rare cases, subconjunctival hemorrhage may be the first presenting sign of serious systemic conditions such as idiopathic thrombocytopenic purpura 4 or ocular adnexal lymphoma 5
• Patients with recurrent subconjunctival hemorrhages and a salmon-pink-colored lesion involving the conjunctiva should be evaluated for possible ocular adnexal lymphoma 5
• Patients with systemic vascular diseases tend to have more extensive subconjunctival hemorrhages compared to traumatic cases 3

Follow-up

• Routine follow-up is not necessary for isolated, non-recurrent subconjunctival hemorrhage
• If the hemorrhage does not resolve within 2-3 weeks or if new hemorrhages develop, further evaluation is recommended

Remember that while subconjunctival hemorrhage appears dramatic and concerning to patients, it is typically harmless and self-limiting. Proper patient education and reassurance are essential components of management.