Subconjunctival Hemorrhage Treatment
Subconjunctival hemorrhage requires no specific treatment—observation with artificial tears for comfort is the primary management, as these hemorrhages are benign and self-limiting, typically resolving within 1-2 weeks. 1
Primary Management Approach
- No active intervention is needed for isolated subconjunctival hemorrhage, as the condition resolves spontaneously without treatment. 1
- Artificial tears can be used to relieve mild irritation or foreign body sensation during the resolution period. 1
- Cold compresses may provide symptomatic relief when applied for 20-30 minutes per session using ice and water in a bag surrounded by a damp cloth, with a barrier between the cold source and skin to prevent cold injury. 1
- Patient education about the natural resolution timeline (1-2 weeks) is essential to provide reassurance and prevent unnecessary anxiety. 1
When to Investigate Further
For recurrent or persistent subconjunctival hemorrhages, systematic workup for underlying conditions is mandatory, as these may indicate serious systemic or ocular pathology. 1, 2
Specific Red Flags Requiring Investigation:
- Salmon-pink conjunctival lesion accompanying recurrent hemorrhage suggests possible ocular adnexal lymphoma and warrants immediate biopsy. 1, 3
- Conjunctival nodules or granulomas require tissue diagnosis. 1, 3
- Yellowish discoloration with subconjunctival multilobulated yellow mass may indicate sebaceous carcinoma. 3
- Painless brown or fleshy-pink lesions raise concern for conjunctival melanoma. 3
Systemic Workup for Recurrent Cases:
- Check blood pressure, as systemic hypertension is a common cause, particularly in older patients. 2, 4
- Review anticoagulation therapy status (warfarin, direct oral anticoagulants), though these medications should not be discontinued for subconjunctival hemorrhage alone. 1, 3, 5
- Screen for diabetes and other vascular diseases in elderly patients. 2
- Consider bleeding disorders only if other bleeding manifestations are present, as hemostatic abnormalities are no more prevalent in recurrent subconjunctival hemorrhage patients than in the general population. 6
Important Clinical Pitfalls
- Do not routinely order coagulation studies for isolated or recurrent subconjunctival hemorrhage without other bleeding symptoms—the prevalence of hemostatic alterations is not higher than in healthy controls. 6
- Anticoagulation therapy does not need to be stopped, as subconjunctival hemorrhages are self-limiting, pose no visual threat, and are considered minor bleeding events. 1
- When subconjunctival hemorrhage occurs with viral conjunctivitis (particularly adenoviral), focus management on the underlying infection with topical lubricants and avoid unnecessary antibiotics. 1, 3
Follow-Up Strategy
- No follow-up is needed for isolated, first-time subconjunctival hemorrhage that resolves as expected. 1
- Schedule follow-up within 1-2 weeks if symptoms of associated viral conjunctivitis persist. 1
- For recurrent cases without identifiable cause after initial workup, consider referral to rule out occult malignancy. 1, 3