From the Guidelines
Subconjunctival hemorrhage is a benign condition that typically resolves on its own within 1-2 weeks without treatment, and continuation of anticoagulant therapy, such as warfarin, is recommended unless otherwise directed by a doctor. According to a study published in the journal Blood 1, patients on chronic warfarin who underwent ophthalmologic procedures, including those that may cause subconjunctival hemorrhage, had a low risk of clinically relevant bleeding and rare thromboembolic outcomes. The study found that the risk of bleeding was increased in patients who continued warfarin, but almost all bleeds were self-limiting, consisting of dot hyphemas or subconjunctival bleeds without compromised visual acuity.
Some key points to consider when managing a subconjunctival hemorrhage include:
- Avoiding rubbing the eyes to prevent further irritation
- Using artificial tears, such as Refresh or Systane, 3-4 times daily to alleviate mild irritation
- Taking a break from contact lenses until the hemorrhage resolves
- Seeking medical attention if the hemorrhage is large, painful, affects vision, recurs frequently, or is accompanied by bleeding elsewhere, as these could indicate underlying conditions that require treatment
It is essential to note that subconjunctival hemorrhages are usually harmless and caused by minor trauma, coughing, sneezing, or straining. However, if you are on blood thinners, it is crucial to continue taking them unless directed otherwise by your doctor, as the risk of thromboembolic outcomes is rare but potentially severe 1.
From the Research
Definition and Risk Factors
- Subconjunctival hemorrhage is a benign disorder that is a common cause of acute ocular redness 2
- The major risk factors include trauma and contact lens usage in younger patients, whereas among the elderly, systemic vascular diseases such as hypertension, diabetes, and arteriosclerosis are more common 2
- Other potential causes of subconjunctival hemorrhage include infection, medications, or systemic disease 3
Diagnosis and Management
- A comprehensive work-up of a patient with subconjunctival hemorrhage is necessary, including a thorough case history to rule out underlying causes 3
- In patients with recurrent or persistent subconjunctival hemorrhage, further evaluation is warranted, including workup for systemic hypertension, bleeding disorders, systemic and ocular malignancies, and drug side effects 2
- There is no direct evidence in the provided studies to support the use of artificial tears in the management of subconjunctival hemorrhage, as the study on artificial tears focuses on their role in dry eye disease management 4
Unrelated Studies
- A study on radio gas chromatography for evaluation of sub-cellular hormone synthesis in the androgen insensitivity syndrome is not relevant to subconjunctival hemorrhage 5