Management of Small Subconjunctival Hemorrhage
No specific treatment is required for isolated subconjunctival hemorrhage, as it is a benign, self-limiting condition that resolves spontaneously within 1-2 weeks. 1
Immediate Management
Reassurance is the cornerstone of management. The condition appears as a bright red patch on the white of the eye due to blood leaking between the conjunctiva and sclera, but it does not affect vision or involve structures critical to sight. 2
Symptomatic Relief
- Artificial tears can be used to relieve mild irritation or foreign body sensation 1
- Cold compresses may provide comfort when applied for 20-30 minutes per session, using a barrier (thin towel) between the cold source and skin to prevent cold injury 1
- The most effective cooling is achieved with a bag of ice and water surrounded by a damp cloth 1
Patient Education
Educate patients about the natural course: 1
- The hemorrhage typically resolves within 1-2 weeks without intervention
- The blood will gradually change color (red to yellow-brown) as it resorbs
- This is a benign condition that does not threaten vision
Assessment for Underlying Causes
Check for Associated Viral Conjunctivitis
Examine for: 1
- Preauricular lymphadenopathy
- Follicular reaction on conjunctival examination
If viral conjunctivitis is present, management should focus on the underlying infection with topical lubricants for comfort. 1 Avoid antibiotics as they are ineffective for viral infections. 1
Evaluate for Trauma
If trauma is present, visual acuity assessment is critical. Eyes with visual acuity <20/40 have a 5.27 times higher odds of having additional ocular injuries requiring specialized evaluation. 3
Special Populations
Anticoagulated Patients
Continue anticoagulation without interruption or dose adjustment. 1 Isolated subconjunctival hemorrhage does not meet criteria for major bleeding (no critical site bleeding, no hemodynamic instability, no hemoglobin drop ≥2 g/dL). 1
- Most bleeds in anticoagulated patients undergoing ophthalmologic procedures are self-limiting without visual compromise 1
- Do not administer reversal agents (vitamin K, prothrombin complex concentrates, idarucizumab, or andexanet alfa) 1
- Provide local therapy (artificial tears, cold compresses) for symptomatic relief 1
Recurrent or Persistent Cases
For patients with recurrent spontaneous subconjunctival hemorrhage without identifiable cause, routine hemostatic screening is not indicated as the prevalence of bleeding disorders is no different from the general population. 4
However, further evaluation is warranted if: 5
- Hemorrhages are recurrent or persistent
- Patient has no history of trauma or contact lens use (common in younger patients)
- Systemic risk factors are present (hypertension, diabetes, arteriosclerosis in elderly) 5
Red Flags Requiring Further Investigation
Refer for specialized evaluation if: 1
- Persistent pain accompanies the hemorrhage
- Signs of infection are present
- Blurred vision occurs (suggests concurrent trauma to other eye structures) 2
- Hemorrhage is recurrent without clear cause (rare cases may indicate systemic disorders like thrombocytopenia or malignancy) 6, 7