Management of Subconjunctival Hemorrhage
Subconjunctival hemorrhages are best treated with observation alone as they typically resolve spontaneously without intervention within 5-14 days. 1
Clinical Assessment
Determine if the hemorrhage is:
- Isolated/spontaneous
- Traumatic
- Recurrent/persistent
- Post-surgical
Evaluate for associated symptoms:
- Pain (usually absent in benign cases)
- Visual changes (should be absent)
- Discharge (suggests alternative diagnosis)
Management Approach
First-line Management
- Reassurance to the patient about the benign and self-limiting nature
- Observation without specific intervention
- Patient education about expected resolution timeline (5-14 days)
- Artificial tears if mild foreign body sensation is present 1
When to Consider Additional Evaluation
Recurrent or persistent subconjunctival hemorrhages warrant further investigation for:
- Systemic hypertension
- Bleeding disorders (e.g., thrombocytopenia) 2
- Anticoagulation medication effects
- Systemic vascular diseases (diabetes, arteriosclerosis) 3
- Ocular or systemic malignancies (rarely, can be first sign of ocular adnexal lymphoma) 4
Special Considerations
Post-surgical Subconjunctival Hemorrhage
- Common after strabismus or other ocular surgeries
- Requires only observation 1
- No need to discontinue anticoagulants for strabismus surgery, as subconjunctival hemorrhage is a minor, self-limiting complication 1
Traumatic Subconjunctival Hemorrhage
- Evaluate for associated ocular trauma
- Rule out globe rupture if history of significant trauma
- Otherwise, management is the same as spontaneous cases
Prevention in High-Risk Settings
- For patients undergoing procedures like intravitreal injections, topical oxymetazoline 30 minutes before the procedure can reduce the incidence of subconjunctival hemorrhage 5
Follow-up Recommendations
- Routine follow-up is not necessary for isolated, non-recurrent subconjunctival hemorrhages
- For recurrent cases, follow-up within 2-4 weeks is appropriate to:
- Confirm resolution
- Evaluate for underlying causes
- Consider referral for systemic workup if appropriate
Patient Education Points
- Subconjunctival hemorrhages look alarming but are harmless
- No eye drops or medications are needed for treatment
- Avoid rubbing the eyes during healing
- Return if the hemorrhage doesn't resolve within 2 weeks or if vision changes occur
- Seek medical attention if hemorrhages recur frequently, as this may indicate an underlying condition requiring treatment 3