Treatment of Subconjunctival Hemorrhage
No specific treatment is required for subconjunctival hemorrhage—it is benign and self-limiting, typically resolving within 1-2 weeks without intervention. 1, 2
Immediate Management
Observation with artificial tears for comfort is the primary management approach. 1 The condition resolves spontaneously as the blood is reabsorbed, and no active intervention accelerates this process. 2
Symptomatic Relief Options
- Artificial tears can be used to relieve mild irritation or foreign body sensation. 1, 2
- Cold application may provide comfort when applied for 20-30 minutes per session using ice and water in a bag surrounded by a damp cloth, with a barrier (such as a thin towel) between the cold source and skin to prevent cold injury. 2
- Patient education about the natural resolution timeline (1-2 weeks) is essential to prevent unnecessary anxiety. 1, 2
Critical Clinical Pitfall: When to Investigate Further
While isolated subconjunctival hemorrhage requires no treatment, recurrent or persistent hemorrhages mandate investigation for underlying systemic conditions. 1, 3
Red Flags Requiring Workup
- Recurrent hemorrhages warrant systematic evaluation for hypertension, diabetes, bleeding disorders, anticoagulation therapy effects, and rarely, ocular malignancies. 1, 3
- Salmon-pink conjunctival lesion accompanying hemorrhage suggests possible ocular adnexal lymphoma—this requires biopsy. 1, 4
- Conjunctival nodules or granulomas warrant biopsy to rule out malignancy. 1
- Persistent pain or signs of infection require further investigation. 2
The importance of recognizing these warning signs cannot be overstated: ocular adnexal lymphoma can present initially as recurrent subconjunctival hemorrhage. 1, 4
Special Population: Anticoagulated Patients
Anticoagulation therapy does not need to be discontinued for subconjunctival hemorrhage. 1, 2 These hemorrhages are generally considered a minor bleeding risk, are self-limiting, and do not compromise visual acuity. 1, 2 Most bleeds in anticoagulated patients resolve without intervention. 2
For surgical procedures, many surgeons do not routinely stop anticoagulants, though temporary discontinuation may reduce bleeding; consultation with the prescribing physician is advised. 1
Associated Viral Conjunctivitis
When subconjunctival hemorrhage occurs with viral conjunctivitis (check for preauricular lymphadenopathy and follicular reaction), focus management on the underlying viral infection using topical lubricants for comfort, and avoid antibiotics. 1, 2 Antibiotics are ineffective for viral infections. 2
Topical corticosteroids may be considered for severe viral conjunctivitis with marked chemosis, eyelid swelling, or membranous conjunctivitis, but only under close supervision. 2