What is the management for subconjunctival (subconjunctival hemorrhage) hemorrhage?

Management of Subconjunctival Hemorrhage

For isolated subconjunctival hemorrhage, observation with artificial tears for comfort is the only management needed, as this is a benign, self-limiting condition that resolves within 1-2 weeks without intervention. 1, 2

Immediate Management

• No specific treatment is required for isolated subconjunctival hemorrhage 1, 2
• Artificial tears can be used to relieve mild irritation or discomfort 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 natural resolution within 1-2 weeks is essential 1, 2

When to Investigate Further

For recurrent or persistent subconjunctival hemorrhages, systematic workup is mandatory to identify underlying conditions 1, 3:

• Check blood pressure for hypertension 1, 3
• Screen for diabetes mellitus 1, 3
• Evaluate for bleeding disorders (though research shows prevalence is not higher than general population) 1, 4
• Review anticoagulation therapy status 1, 3
• Look for a salmon-pink conjunctival lesion, which suggests possible ocular adnexal lymphoma 1, 5
• Consider systemic and ocular malignancies in the differential 1, 3

Critical Pitfalls to Avoid

• Do not miss ocular adnexal lymphoma: recurrent subconjunctival hemorrhage with a salmon-pink lesion warrants immediate biopsy 1, 5
• Do not routinely order hemostatic screening tests for isolated recurrent subconjunctival hemorrhage without other bleeding manifestations, as the prevalence of hemostatic abnormalities is not different from the general population 4
• Conjunctival nodules or granulomas require biopsy 1
• Persistent pain or signs of infection require further investigation 2

Anticoagulation Management

• Do not discontinue anticoagulation therapy for subconjunctival hemorrhage 1, 2
• These hemorrhages are 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

Follow-Up Strategy

• No follow-up is needed for isolated, first-time subconjunctival hemorrhage that resolves as expected 1
• Follow-up within 1-2 weeks only if symptoms of associated viral conjunctivitis persist 2