Conjunctival Hemorrhage Does Not Require Eye Drops
Conjunctival hemorrhage (subconjunctival hemorrhage) is a benign, self-limited condition that requires no treatment—no eye drops are indicated. 1
Why No Treatment Is Needed
- Subconjunctival hemorrhage resolves spontaneously within 1-3 weeks without intervention, as the blood is naturally reabsorbed by the body 1
- The condition is essentially a bruise on the white of the eye—just as you wouldn't treat a skin bruise with medication, conjunctival hemorrhage needs no drops 1
- Artificial tears or lubricants may be used for comfort if the patient experiences mild irritation, but they do not accelerate healing 2
What You Should Actually Do Instead
Focus on identifying the underlying cause rather than treating the hemorrhage itself:
- In younger patients (under 50): Look for trauma history or contact lens use as the primary risk factors 1
- In elderly patients: Evaluate for systemic vascular disease including hypertension, diabetes, and arteriosclerosis 1
- For recurrent or bilateral hemorrhages: Investigate blood dyscrasias, coagulopathy (including anticoagulant use), or increased intrathoracic pressure from vomiting/coughing 3
- In children with SCH: Examine carefully for other signs of trauma, as 83% of pediatric cases are trauma-related 4
Critical Red Flags Requiring Referral
Refer immediately to ophthalmology if any of these are present:
- Visual changes or decreased visual acuity 5
- Eye pain (not just mild discomfort) 5
- Associated orbital mass or swelling 5
- Recurrent episodes without clear cause 1
- Bilateral presentation 3
- Severe or extensive hemorrhage 3
Common Pitfalls to Avoid
- Do not prescribe topical antibiotics—conjunctival hemorrhage is not infectious and antibiotics provide no benefit while risking toxicity and resistance 6
- Do not use topical corticosteroids—these actually increase the risk of spontaneous subconjunctival hemorrhage with long-term use (10% prevalence in chronic steroid users) 7
- Do not overlook anticoagulation as a cause—patients on warfarin or other anticoagulants with prolonged PT/INR can develop severe recurrent hemorrhages requiring anticoagulation adjustment 3
- Do not miss hematologic disorders—essential thrombocythemia and other blood dyscrasias can present with severe spontaneous ocular bleeding requiring systemic treatment 5
Patient Counseling
- Reassure the patient that the appearance is alarming but the condition is harmless 1
- The redness will worsen before improving (spreading and turning yellow-brown as blood breaks down) over 7-14 days 1
- Avoid eye rubbing and straining (Valsalva maneuvers) during healing 1
- Return if pain, vision changes, or recurrence develops 1