Treatment of Subconjunctival Hemorrhage
No specific treatment is required for subconjunctival hemorrhage—observation alone is appropriate as this is a benign, self-limiting condition that resolves within 1-2 weeks without intervention. 1, 2
Primary Management Approach
- Observation is the mainstay of treatment for isolated subconjunctival hemorrhage, with artificial tears used only for symptomatic relief of mild irritation 1, 2
- Patient education about the natural resolution timeline (1-2 weeks) is essential to prevent unnecessary anxiety and follow-up 1, 2
Symptomatic Relief Options
- Artificial tears can be applied as needed to relieve mild irritation or foreign body sensation 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
When to Investigate Further: Red Flags for Recurrent Cases
For patients with recurrent or persistent subconjunctival hemorrhages, systematic investigation is mandatory to exclude underlying pathology 1:
- Check blood pressure and screen for diabetes 1
- Review anticoagulation therapy and bleeding disorder history 1
- Look for a salmon-pink conjunctival lesion, which suggests possible ocular adnexal lymphoma—this is a critical finding that requires biopsy 1, 3
- Any conjunctival nodules or granulomas warrant biopsy 1
- Consider hemostatic screening only if there are other bleeding manifestations, as the prevalence of hemostatic abnormalities in isolated recurrent SCH is not different from the general population 4
Critical Pitfalls to Avoid
- Do not discontinue anticoagulation therapy for subconjunctival hemorrhage—these hemorrhages are considered a minor bleeding risk, are self-limiting, and do not compromise visual acuity 1, 2
- Do not prescribe antibiotics for subconjunctival hemorrhage, as they are ineffective unless there is concurrent bacterial infection 2
- Do not miss associated viral conjunctivitis—check for preauricular lymphadenopathy and follicular reaction, and manage the underlying viral infection with topical lubricants 2
- Do not ignore persistent pain or signs of infection—these require further investigation beyond simple observation 2
Special Clinical Scenarios
Patients on Anticoagulation
- Continue anticoagulation therapy without interruption 1, 2
- Reassure patients that subconjunctival hemorrhage does not indicate dangerous bleeding 1
Associated with Viral Conjunctivitis
- Focus management on the underlying viral infection 1, 2
- Use topical lubricants for comfort 1, 2
- Consider topical corticosteroids only for severe cases with marked chemosis, eyelid swelling, or membranous conjunctivitis, under close supervision 2
Long-term Topical Steroid Users
- Be aware that chronic topical corticosteroid use substantially increases the prevalence of spontaneous subconjunctival hemorrhage due to steroid-induced vascular fragility 5
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 only if symptoms of viral conjunctivitis persist 1, 2
- For recurrent cases, follow-up should focus on investigating underlying systemic conditions rather than the hemorrhage itself 1