What is a Subconjunctival Hemorrhage?
A subconjunctival hemorrhage is a red spot on the white of your eye (sclera). These hemorrhages are the result of a broken blood vessel. While they can look scary, they are usually harmless and will heal on their own in about 1 to 2 weeks.
The conjunctiva of our eyes is a transparent, thin layer of tissue that protects the sclera. It is responsible for lubricating our eyes with mucus and tears and keeps bacteria out. The conjunctiva is also highly vascular and contains several tiny blood vessels.
A subconjunctival hemorrhage occurs when a blood vessel in the eye breaks, allowing blood to seep between the conjunctival layer and the sclera. This results in one or more visible red spots on the white of the eye. It also might spread and cover the entire sclera.
Symptoms of a Subconjunctival Hemorrhage
Having blood in your eye is alarming, but a subconjunctival hemorrhage is typically painless. You may not even know you have a red spot on your eye until someone points it out or you look in the mirror.
Sometimes you might experience mild irritation, but it won't affect your vision or interfere with daily activities.
What Causes Subconjunctival Hemorrhages?
Spontaneous subconjunctival hemorrhages commonly occur from a quick elevation in blood pressure that can rupture the tiny blood vessels in your eyes.
This can happen from simple activities, such as:
- Coughing
- Sneezing
- Straining from constipation
- Rubbing your eyes
- Strenuous exercises/lifting
Other causes of subconjunctival hemorrhage include environmental and outside forces, such as:
- Eye injury
- Acute Trauma
- Viral Infection
- Prolonged use of disposable contact lenses
A subconjunctival hemorrhage can also be caused by a secondary medical condition or medication that makes the capillaries on the eye more vulnerable to bursting.
These secondary causes include:
- Diabetes
- High blood pressure (hypertension)
- High cholesterol
- Blood thinners, including aspirin, warfarin (brand name Coumadin)
- Bleeding disorders
- Severe asthma attack
In younger people, risk factors associated with subconjunctival hemorrhage include eye injury and contact lens usage. In older adults, hypertension, diabetes, and other chronic illnesses can increase the chance of subconjunctival bleeding.
Bleeding and a blood clotting disorder can also put you at a higher risk. Elderly adults are at a higher risk for subconjunctival hemorrhage because blood vessels become more fragile with age.
Chances of developing a subconjunctival hemorrhage also increase after undergoing eye surgery. This includes cataract and refractive surgeries and the use of some forms of local anesthesia.
Subconjunctival Hemorrhages in Children
A subconjunctival hemorrhage can happen to people of all ages, including children and infants.
In children, these hemorrhages typically occur from non-medical issues, including:
- Sneezing
- Coughing
- Vomiting
- Strain from using the bathroom
- Forceful rubbing of the eyes
- Eye injury or trauma
Newborns can also develop a subconjunctival hemorrhage during childbirth. This commonly occurs during a stressful birth when the pressure from labor contractions causes the baby's blood vessels to burst. While scary, it is not harmful and will heal without medical care.
Other reasons for a newborn to have a subconjunctival hemorrhage include:
- High birth weight
- Extreme force used to pull the baby out of the birth canal
- Use of forceps or vacuum extractor
- If the umbilical cord was around the neck
Although rare, subconjunctival hemorrhage in infants and children can also be a sign of nonaccidental trauma from child abuse. Nonaccidental trauma should be considered if there is subconjunctival bleeding in both eyes, paired with facial petechiae (tiny spots of bleeding under the skin).
As with adults, the only sign of a subconjunctival hemorrhage in infants and children is a red spot on the white of the eye, which may spread before resolving itself in 1 to 2 weeks. As the body reabsorbs the blood, you may see a yellowish color before it fully heals.
Unless an injury or infection causes the bleeding, no treatment is needed. If the eye becomes irritated, you can use artificial tears for relief.
When to See a Medical Professional
While a subconjunctival hemorrhage typically goes away on its own, you should seek medical help if it is still visible 2 to 3 weeks after it appears.
Other reasons to seek medical care for a subconjunctival hemorrhage include:
- Bilateral hemorrhage in both eyes at the same time
- Frequent occurrences
- Eye pain
- If blood moves to the color part of the eye (iris)
Diagnosis
A subconjunctival hemorrhage is diagnosed if a red spot is visible on the white of the eye. No other factors are necessary for a diagnosis.
Treatment
Medical treatment is unnecessary, as the condition will clear up on its own.
If there is an infection, injury, or secondary medical condition causing the bleeding, a medical professional or eye doctor will treat the underlying problem. A comprehensive eye exam and blood work might also be necessary if healthcare professionals suspect a medical condition is to blame for the bleeding.
Artificial tears or eye drops can relieve mild irritation. A cold compress or washcloth can also reduce discomfort. Wash your hands often and avoid touching your eyes.
Complications
There are typically no complications associated with having a subconjunctival hemorrhage.
However, it can be a sign of an underlying medical condition such as a blood clot or blood thinning disorder, high blood pressure, or diabetes.
Prognosis
A subconjunctival hemorrhage is usually harmless and will clear up on its own in 1 to 2 weeks. It is not associated with any pain or vision changes.
Seek medical attention if you take blood thinners or have an underlying medical condition that affects the vascular system.
Prevention
While some subconjunctival hemorrhages can’t be prevented, practicing good eye care is the best way to avoid a broken blood vessel in your eye.
Ways to practice good eye hygiene can include:
- Be gentle when rubbing your eyes
- Wash your hands and avoid touching your eyes
- Wear protective eye gear
- Treat high blood pressure and/or bleeding disorders
- Routinely clean and change your contact lenses
Summary
A subconjunctival hemorrhage is the result of a broken blood vessel in your conjunctiva. It appears as a bright red spot on the eye surface.
It is typically harmless and will heal in a few weeks by reabsorbing the blood back into your body. The bleeding may increase, and a yellowish color may form before it heals.
Elderly adults are at a higher risk of getting a subconjunctival hemorrhage because blood vessels become more fragile with age. Older adults are also prone to having a severe vascular disorder, which can increase the chances of getting a subconjunctival hemorrhage.
Children and infants typically get a subconjunctival hemorrhage from eye injury, infection, or other activities that quickly change blood pressure.
Diagnosis includes observing the eye for red spots. Treatment is minimal and may include artificial tears to relieve irritation. Seek medical attention if it does not clear up after 3 weeks, occurs frequently, or is the result of an injury or infection.
The best way to prevent a subconjunctival hemorrhage is to practice good eye hygiene, avoid eye injury, and manage any secondary medical conditions that can affect the vascular system.
