Treatment of Subconjunctival Hemorrhage (Popped Eye Vessel)
No treatment is necessary for subconjunctival hemorrhage—it resolves spontaneously without intervention. 1
Immediate Management
- Reassure the patient that this is a benign, self-limited condition that will resolve on its own, typically within 1-2 weeks 1
- No eye drops, antibiotics, or medications are needed for uncomplicated subconjunctival hemorrhage 1
- Artificial tears may be used if the patient experiences mild irritation or foreign body sensation, though this does not speed resolution 1
When to Investigate Further
While most subconjunctival hemorrhages are benign, certain red flags warrant additional workup:
Recurrent or Persistent Hemorrhages
- Check blood pressure immediately in the office, as hypertension is a major risk factor in elderly patients 1
- Screen for diabetes and arteriosclerosis in older patients with recurrent episodes 1
- Obtain complete blood count with platelet count to rule out thrombocytopenia or other hematologic disorders 2, 1
- Review medication list for anticoagulants, antiplatelet agents, or NSAIDs that may contribute 3
- Consider bleeding disorder workup (PT/INR, aPTT, bleeding time) only if hemorrhages are truly recurrent (3+ episodes) and no other cause is identified 3
Concerning Features Requiring Urgent Evaluation
- Bilateral hemorrhages with other bleeding manifestations (petechiae, bruising, mucosal bleeding) suggest systemic coagulopathy or thrombocytopenia 2
- Salmon-pink conjunctival lesion associated with recurrent hemorrhage raises concern for ocular adnexal lymphoma and requires biopsy 4
- Associated vision changes, pain, or proptosis are not typical of simple subconjunctival hemorrhage and warrant immediate ophthalmology referral 1
Important Clinical Pearls
- Trauma and contact lens use are the most common causes in younger patients 1
- Hypertension, diabetes, and arteriosclerosis are the most common causes in elderly patients 1
- Most patients with recurrent subconjunctival hemorrhage have no identifiable hemostatic abnormality—extensive coagulation testing is not cost-effective unless there are other bleeding symptoms 3
- The hemorrhage appears worse before it gets better as blood spreads under the conjunctiva in the first 24-48 hours; warn patients about this to prevent unnecessary anxiety 1
Follow-Up
- No routine follow-up is needed for isolated, first-time subconjunctival hemorrhage 1
- Return if hemorrhage recurs (≥3 episodes) or if new symptoms develop 1, 3
- Blood pressure control and management of underlying vascular disease are the only interventions that reduce recurrence risk in at-risk patients 1