What is the appropriate treatment for an adult patient with no significant past medical history presenting with conjunctivital hemorrhage?

Treatment for Conjunctival Hemorrhage (Subconjunctival Hemorrhage)

Subconjunctival hemorrhage requires no specific treatment in the vast majority of cases—it is a benign, self-limited condition that resolves spontaneously within 1-2 weeks without intervention. 1

Immediate Management

• Reassurance is the primary intervention, as subconjunctival hemorrhage is a benign disorder that resolves without treatment. 1
• Artificial tears may be used for symptomatic relief if the patient experiences mild irritation or foreign body sensation (instill 1-2 drops in the affected eye as needed). 2
• No antibiotics, corticosteroids, or other medications are indicated for uncomplicated subconjunctival hemorrhage. 1

Critical Assessment: Rule Out Underlying Causes

While treatment is supportive, you must evaluate for potential underlying conditions that may require intervention:

In Younger Patients (< 50 years):

• Trauma is the most common cause—obtain detailed history of eye rubbing, contact lens use, or minor ocular trauma. 1, 3
• Contact lens usage is a major risk factor in this age group. 1
• In children specifically, trauma accounts for 83% of cases, and all children with subconjunctival hemorrhage should be closely examined for other signs of ocular or non-ocular trauma. 3

In Older Patients (≥ 50 years):

• Systemic vascular diseases are more common causes, including hypertension, diabetes, and arteriosclerosis. 1
• Check blood pressure at the visit, as uncontrolled hypertension may be the underlying trigger. 1
• Review medications, particularly anticoagulants, antiplatelet agents (aspirin can cause bilateral subconjunctival hemorrhage), and long-term topical corticosteroids (which increase vascular fragility and substantially increase prevalence of spontaneous hemorrhage). 4, 5

Red Flags Requiring Further Workup:

• Recurrent or persistent hemorrhages warrant evaluation for systemic hypertension, bleeding disorders (coagulopathy), systemic malignancies, ocular malignancies, and medication side effects. 1, 6
• Severe spontaneous bleeding around the eye should prompt consideration of hematologic disorders like essential thrombocythemia. 6
• Bilateral presentation may suggest systemic causes such as aspirin overdose, coagulopathy, or hematologic disorders. 6, 5

Follow-Up Recommendations

• No routine follow-up is needed for isolated, first-time subconjunctival hemorrhage in otherwise healthy patients. 1
• Instruct the patient that the hemorrhage will resolve spontaneously over 1-2 weeks as the blood is reabsorbed. 1
• Return if visual changes, pain, or recurrent hemorrhages occur, as these warrant further evaluation. 1

Common Pitfalls to Avoid

• Do not prescribe antibiotics—subconjunctival hemorrhage is not infectious and does not respond to antimicrobial therapy. 1
• Do not use topical corticosteroids—these can actually increase the risk of spontaneous hemorrhage with long-term use due to steroid-induced vascular fragility. 4
• Do not miss underlying coagulopathy or hematologic disorders in patients with recurrent or bilateral hemorrhages. 1, 6
• Do not overlook occult trauma in children—subconjunctival hemorrhage can be a sign of abusive injury, and all children require close examination for other signs of trauma. 3