Duration of Subconjunctival Hemorrhage
A subconjunctival hemorrhage typically resolves completely within 1 to 2 weeks without treatment, though larger hemorrhages may take up to 3 weeks to fully clear.
Expected Timeline
- Most subconjunctival hemorrhages resolve within 7-14 days as the blood is gradually reabsorbed by the conjunctival tissue 1
- The hemorrhage typically appears bright red initially, then transitions through yellow-brown discoloration as it resolves, similar to a bruise on the skin 1
- Larger or more extensive hemorrhages may require up to 3 weeks for complete resolution 1
Clinical Course and Monitoring
- The condition is benign and self-limited in the vast majority of cases, requiring no specific treatment 1
- Patients should be reassured that the dramatic appearance does not indicate serious ocular damage 1
- No treatment accelerates resolution - the blood must be naturally reabsorbed over time 1
When to Investigate Further
While most subconjunctival hemorrhages are idiopathic or related to minor trauma, recurrent or persistent hemorrhages warrant investigation:
- Recurrent hemorrhages (multiple episodes over months) should prompt evaluation for underlying causes including coagulopathy, though hemostatic abnormalities are found in only a small minority of cases 2
- A hemorrhage that persists beyond 3 weeks or recurs in the same location may indicate an underlying conjunctival lesion, including rare cases of ocular adnexal lymphoma 3
- Spontaneous hemorrhage as an isolated first presentation can rarely be the initial sign of systemic disorders such as idiopathic thrombocytopenic purpura 4
Important Clinical Pitfalls
- In children with subconjunctival hemorrhage, trauma accounts for 83% of cases, and a thorough examination for other signs of ocular or non-ocular trauma is essential 5
- Acute hemorrhagic conjunctivitis (caused by enterovirus 70 or coxsackievirus A24) presents with subconjunctival hemorrhage plus severely painful conjunctivitis and resolves in 5-7 days, but this is a distinct infectious entity 1
- Subconjunctival hemorrhage associated with purulent discharge, pain, photophobia, or decreased vision requires urgent evaluation to rule out more serious conditions 6, 7