Management of Painless Subconjunctival Hemorrhage in a Healthy Adult
Primary Recommendation
No specific treatment is required for isolated subconjunctival hemorrhage, as it is a benign, self-limiting condition that will resolve spontaneously within 1-2 weeks. 1
Initial Management
Reassurance is the cornerstone of management – explain to the patient that this is a common, harmless condition where blood has leaked from small vessels between the conjunctiva and sclera 1
Artificial tears can be used for mild irritation or foreign body sensation if present 1
Cold compresses may provide comfort – apply for 20-30 minutes per session with a barrier (thin towel) between the cold source and skin to prevent cold injury 1
What to Rule Out
Before confirming this is simple subconjunctival hemorrhage, verify the absence of:
- Pain (persistent pain requires further investigation) 1
- Vision changes (any visual disturbance warrants ophthalmology referral) 2
- Purulent discharge or matting (suggests infectious conjunctivitis requiring culture and antibiotics) 1
- Preauricular lymphadenopathy or follicular reaction (indicates viral conjunctivitis) 1
- Corneal involvement (requires immediate ophthalmology referral) 2
Follow-Up Recommendations
Routine follow-up is not necessary for uncomplicated subconjunctival hemorrhage. 1 However:
Return immediately if you develop pain, vision changes, purulent discharge, or the hemorrhage does not begin to fade within 2 weeks 1
If associated with viral conjunctivitis symptoms, follow up within 1-2 weeks if symptoms persist 1
Special Considerations for Recurrent Episodes
If subconjunctival hemorrhage recurs multiple times, consider:
Blood pressure screening – hypertension is a common risk factor in older adults 3
Review medications – particularly anticoagulants, antiplatelet agents, and NSAIDs 4
However, routine hemostatic screening is NOT indicated – studies show the prevalence of bleeding disorders in recurrent spontaneous subconjunctival hemorrhage is no different from the general population 4
Rare warning sign: Persistent or recurrent hemorrhage with a salmon-pink conjunctival lesion may indicate ocular adnexal lymphoma and requires ophthalmology referral 5
Common Pitfalls to Avoid
Do not prescribe antibiotics – they are ineffective for non-infectious subconjunctival hemorrhage and contribute to resistance 1
Do not order coagulation studies unless there are other bleeding manifestations or a strong clinical suspicion of a systemic bleeding disorder 4
Do not stop anticoagulation therapy if the patient is on blood thinners – isolated subconjunctival hemorrhage does not meet criteria for major bleeding and anticoagulation should continue without interruption 1