Management of Subconjunctival Hemorrhage
For isolated subconjunctival hemorrhage, no specific treatment is required as this is a benign, self-limiting condition that resolves spontaneously within 1-2 weeks. 1
Initial Assessment
When a patient presents with subconjunctival hemorrhage, your evaluation should focus on:
- Visual acuity testing to ensure no vision compromise 1
- Examination for preauricular lymphadenopathy and follicular reaction to identify associated viral conjunctivitis 1
- Assessment for persistent pain or signs of infection, which would require further investigation 1
- History of trauma, anticoagulation use, or recurrent episodes to identify patients needing additional workup 2
The key distinction is whether this is an isolated, first-time occurrence versus a recurrent or persistent hemorrhage. Single episodes in otherwise healthy patients require minimal intervention, while recurrent cases warrant investigation for systemic hypertension, bleeding disorders, malignancies, or medication side effects. 2
Conservative Management
Artificial tears are the only intervention recommended to relieve mild irritation or foreign body sensation. 1 This provides symptomatic relief without altering the natural resolution timeline.
Cold compresses may be applied for comfort using ice and water in a bag surrounded by a damp cloth, with a barrier between the cold source and skin. 1 Limit application to 20-30 minutes per session to prevent cold injury. 1
Patient education is essential: explain that the bright red appearance will gradually fade to yellow-brown over 1-2 weeks as the blood resorbs, similar to a bruise. 1 Reassure patients this does not affect vision or eye health.
When to Investigate Further
Recurrent or persistent subconjunctival hemorrhages require workup for underlying systemic conditions. 2 However, routine hemostatic screening in patients with only recurrent subconjunctival hemorrhage and no other bleeding manifestations is not indicated, as the prevalence of coagulation disorders is not higher than the general population. 3
Consider further evaluation when:
- Hemorrhages recur multiple times without identifiable cause 2
- Patient has persistent pain or vision changes 1
- Signs of infection are present 1
- Systemic symptoms suggest underlying disease (e.g., easy bruising, other bleeding sites) 4, 2
In rare cases, recurrent subconjunctival hemorrhage can be the presenting sign of serious conditions including idiopathic thrombocytopenic purpura or ocular adnexal lymphoma. 4, 5
Special Populations
Patients on anticoagulation therapy may experience more severe or recurrent hemorrhages, but this is generally a minor bleeding risk that does not require discontinuation of anticoagulation. 1 These bleeds remain self-limiting without visual compromise. 1
Elderly patients should be evaluated for systemic vascular diseases including hypertension, diabetes, and arteriosclerosis as potential contributing factors. 2
Follow-Up
No routine follow-up is needed for isolated subconjunctival hemorrhage. 1 Instruct patients to return if symptoms persist beyond 2 weeks or if new symptoms develop (pain, vision changes, discharge). 1
If associated with viral conjunctivitis, follow-up within 1-2 weeks is appropriate if symptoms persist. 1 Management should focus on the underlying viral infection with topical lubricants for comfort. 1