Management of Subconjunctival Hemorrhage
Subconjunctival hemorrhage requires observation and supportive care only, with no specific medical intervention needed in the vast majority of cases. 1
Initial Management
The primary approach is reassurance and observation, as subconjunctival hemorrhage is a benign, self-limiting condition. 1 The American Academy of Ophthalmology classifies this as a common postoperative concern best treated with observation or a short course of supportive therapy. 1
Supportive Measures
- Apply cold compresses in the first 24-48 hours to reduce bleeding extension (general ophthalmology practice)
- Use artificial tears for comfort if irritation is present 1
- Avoid aspirin and NSAIDs during the acute phase unless medically necessary 2
The hemorrhage typically resolves spontaneously within 1-2 weeks without intervention, as the blood is reabsorbed naturally. 1
When to Investigate Further
Most cases require no workup, but specific circumstances warrant additional evaluation: 2
Red Flags Requiring Investigation
- Recurrent episodes without identifiable cause - Consider systemic hypertension screening, bleeding disorder workup, and medication review 2, 3
- Bilateral or severe hemorrhages - Evaluate for blood dyscrasias, coagulation disorders, or increased intrathoracic pressure from vomiting/coughing 3
- Patients on anticoagulation therapy - Check PT/INR levels if on warfarin, as prolonged prothrombin time can cause severe hemorrhages 3
- Associated with trauma or contact lens use in younger patients 2
- Elderly patients with vascular risk factors - Screen for hypertension, diabetes, and arteriosclerosis 2
Important caveat: Routine hemostatic screening (bleeding time, PFA-100, platelet aggregometry, von Willebrand testing) is not indicated for isolated subconjunctival hemorrhage, as the prevalence of hemostatic abnormalities is no different from the general population. 4 These tests should only be ordered if there are other bleeding manifestations or strong clinical suspicion. 4
Prevention Strategies
For patients undergoing procedures that may cause subconjunctival hemorrhage (such as intravitreal injections):
- Topical oxymetazoline 30 minutes before the procedure reduces hemorrhage incidence from 72% to 51% 5
- This is a single, cost-effective intervention that improves patient satisfaction and compliance with ongoing treatment 5
Follow-up
No routine follow-up is necessary for uncomplicated cases. 1 Patients should be instructed to return only if:
- The hemorrhage does not resolve within 2-3 weeks
- Vision changes occur
- Pain develops (subconjunctival hemorrhage itself is painless)
- Recurrent episodes occur 2