Subconjunctival Hemorrhage
The medical term for this condition is subconjunctival hemorrhage, which describes bleeding beneath the conjunctiva (the transparent membrane covering the white part of the eye) that appears as a focal red patch on the sclera 1.
Mechanism and Causation
Forceful Valsalva maneuvers, such as vigorous nose-blowing during epistaxis, cause acute venous pressure elevation that ruptures fragile conjunctival capillaries, resulting in blood accumulation between the conjunctiva and sclera 1, 2. This mechanism explains the temporal relationship between the patient's forceful nosebleed and the subsequent eye redness.
Clinical Characteristics
- The hemorrhage typically appears as a well-demarcated, bright red or red-purple patch on the white sclera, most commonly near the medial (inner) or lateral canthus 1, 2
- The condition is usually unilateral and painless, with no associated vision changes 1
- The blood remains confined beneath the conjunctiva and does not extend into the anterior chamber or affect intraocular structures 2
Benign Nature and Self-Resolution
- Isolated subconjunctival hemorrhage in otherwise healthy adults is benign and requires no treatment, as it resolves spontaneously within 1-2 weeks as the blood is reabsorbed 1, 2
- The hemorrhage may initially expand slightly over the first 24-48 hours before gradually fading through yellow-green discoloration as it resolves 2
When Further Evaluation Is Warranted
Most cases require no investigation, but certain red flags mandate additional workup 1, 2:
- Recurrent bilateral subconjunctival hemorrhages without clear precipitating trauma or Valsalva events may indicate underlying coagulopathy or thrombocytopenia 3, 4
- Associated symptoms including severe eye pain unrelieved by topical anesthetics, vision loss, distorted pupil, or copious discharge require urgent ophthalmology referral 1
- Spontaneous hemorrhages in children warrant careful examination for other signs of trauma, as 83% of pediatric cases are trauma-related 4
Common Pitfall to Avoid
Do not confuse subconjunctival hemorrhage with conjunctival hyperemia (diffuse redness from dilated vessels), which appears as generalized pink or red discoloration rather than a discrete blood patch and indicates active inflammation requiring different management 5.