Treatment of Conjunctival Hemorrhage
Conjunctival hemorrhage (subconjunctival hemorrhage) is a benign, self-limited condition that requires no specific treatment in the vast majority of cases—reassurance and observation are sufficient. 1
Immediate Management
No active treatment is necessary for uncomplicated conjunctival hemorrhage. The blood will spontaneously resorb over 1-3 weeks without intervention. 1
Symptomatic Relief (Optional)
- Cool compresses can be applied for comfort if the patient experiences mild irritation, though this does not accelerate resolution 2
- Preservative-free artificial tears may be used if there is associated ocular surface irritation or foreign body sensation 2
- Patients should be instructed to avoid rubbing the eye, as this can potentially worsen any underlying irritation 2
When to Investigate Further
The key clinical decision is determining which patients require additional workup versus simple observation:
Recurrent or Persistent Cases Warrant Evaluation
- If hemorrhages recur 2 or more times, investigate for underlying systemic causes including hypertension, diabetes, bleeding disorders, anticoagulant use, and rarely systemic or ocular malignancies 1
- Patients with moderate to severe conjunctivochalasis are at higher risk for recurrent hemorrhages, particularly those engaged in activities requiring visual concentration (reading, computer work, driving) 3
- Laboratory workup should include complete blood count with platelets, coagulation studies, and blood pressure measurement in recurrent cases 1, 4
Age-Specific Risk Factors
- Younger patients: Trauma and contact lens use are the most common causes 1
- Elderly patients: Systemic vascular diseases (hypertension, diabetes, arteriosclerosis) predominate 1
- Children: Trauma accounts for 83% of cases, with ocular surface inflammation (including infectious conjunctivitis) accounting for 13% 5
Red Flags Requiring Ophthalmology Referral
- Decreased vision accompanying the hemorrhage 2
- Severe or worsening pain beyond mild irritation 2
- Recurrent hemorrhages without clear traumatic cause 1
- Associated systemic bleeding (hematuria, petechiae, bruising) suggesting coagulopathy 4
- Inability to visualize the posterior extent of the hemorrhage, raising concern for globe rupture in trauma cases 5
Surgical Consideration for Recurrent Cases
For patients with 3 or more recurrent hemorrhages associated with moderate-to-severe conjunctivochalasis, surgical treatment of the conjunctivochalasis can reduce recurrence by more than 80% 3. This should be considered after conservative measures fail and systemic causes have been excluded.
Critical Pitfall to Avoid
Do not dismiss spontaneous subconjunctival hemorrhage as always benign—it can be the first presenting sign of serious systemic disease, including idiopathic thrombocytopenic purpura, particularly when occurring without trauma 4. A thorough history regarding trauma, medications (especially anticoagulants), and systemic symptoms is essential in every case 1.