Management of Subconjunctival Hemorrhage
Subconjunctival hemorrhage requires no specific treatment—reassurance and observation are the primary management approach, as this is a benign, self-limiting condition that resolves spontaneously within 1-2 weeks. 1, 2
Immediate Management
- Provide reassurance that this is a benign condition with no risk to vision 1, 2
- Apply cold compresses in the first 24-48 hours to potentially reduce bleeding extension (ice and water in a bag surrounded by a damp cloth, applied for 20-30 minutes per session with a barrier between ice and skin) 1, 2
- Prescribe artificial tears for comfort if the patient reports mild irritation 1, 2
Patient Education
- Explain the natural course: blood will be reabsorbed naturally within 1-2 weeks without intervention 1, 2
- Advise return only if the hemorrhage does not resolve within 2-3 weeks or if vision changes occur 2
- No routine follow-up is necessary for uncomplicated cases 2
Clinical Assessment to Rule Out Underlying Causes
While treatment is supportive, assess for conditions requiring further evaluation:
- Check blood pressure in all patients, particularly those over 40 years old, as systemic hypertension is a common cause 3, 4
- Look for signs of viral conjunctivitis: preauricular lymphadenopathy and follicular reaction 1
- Inquire about trauma (more common in younger patients) and contact lens use 3
- Review medications: patients on anticoagulation (warfarin, DOACs) or antiplatelet agents may have more severe hemorrhages, but this is considered a minor bleeding risk and does not require discontinuation of therapy 5, 1
When to Investigate Further
Order additional workup only if:
- Hemorrhages are recurrent or bilateral 3, 6
- Persistent pain is present 1
- Signs of infection develop 1
- Patient has other bleeding manifestations suggesting a systemic bleeding disorder 3
Note: Hemostatic screening tests are not indicated for isolated or even recurrent subconjunctival hemorrhage in patients without other bleeding symptoms, as the prevalence of hemostatic abnormalities is no different from the general population 7
Management of Associated Viral Conjunctivitis
If subconjunctival hemorrhage occurs with viral conjunctivitis:
- Use topical lubricants to improve comfort 1
- Avoid antibiotics as they are ineffective for viral infections 1
- Consider topical corticosteroids only for severe cases with marked chemosis, eyelid swelling, or membranous conjunctivitis, under close supervision 1
- Follow-up within 1-2 weeks if viral conjunctivitis symptoms persist 1
Special Populations
Anticoagulated patients: The hemorrhage may appear more dramatic but remains self-limiting without compromised visual acuity; continuation of anticoagulation is appropriate 5, 1