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, 2
Immediate Management
No active treatment is necessary for uncomplicated subconjunctival hemorrhage. The condition resolves spontaneously as the blood is reabsorbed, typically within 1-2 weeks 2.
Symptomatic Relief (if needed)
- Cool compresses can be applied for comfort if there is mild irritation 3
- Preservative-free artificial tears may be used if the patient experiences dryness or mild discomfort, applied every 2-4 hours as needed 3
- Avoid eye rubbing, which could theoretically worsen the hemorrhage or cause additional trauma 3
Clinical Assessment Priorities
While treatment is minimal, identifying underlying causes is critical:
Check Blood Pressure
- Measure blood pressure in all patients with subconjunctival hemorrhage, particularly elderly patients, as systemic hypertension is one of the most common associated conditions 1, 2
- Hypertension-associated hemorrhages are most frequent in older patients 1
Identify Risk Factors
- Trauma (most common in younger patients, particularly in summer months) 1, 2
- Contact lens use in younger patients 2
- Acute conjunctivitis 1
- Systemic vascular diseases including diabetes and arteriosclerosis in elderly patients 2
When Further Evaluation Is Warranted
For recurrent, bilateral, or severe hemorrhages, investigate underlying systemic causes 2, 4:
- Bleeding disorders or coagulopathy (including anticoagulation therapy side effects) 2, 4
- Blood dyscrasias such as essential thrombocythemia 4, 5
- Systemic or ocular malignancies 2
- Increased intrathoracic pressure from repetitive vomiting or coughing 4
Special Consideration in Children
- In pediatric cases, 83% are due to trauma and 13% to ocular surface inflammation (including infectious conjunctivitis) 6
- All children with subconjunctival hemorrhage should be carefully examined for other signs of trauma, as it can be a sign of occult injury, though this is uncommon 6
What NOT to Do
- Do not prescribe topical antibiotics unless there is concurrent infectious conjunctivitis 1
- Do not use topical corticosteroids for simple subconjunctival hemorrhage 7
- Avoid topical vasoconstrictors, which are unnecessary and can cause rebound vasodilation 7