Subconjunctival Hemorrhage

What is a Subconjunctival Hemorrhage?

A subconjunctival hemorrhage refers to a broken blood vessel in the conjunctiva (a transparent membrane that borders the inside of the eyelid and spans across the white of the eye). 

The conjunctiva has many tiny blood vessels that can break under certain conditions, such as blunt trauma to the eye. When there is a breakage, blood can seep under the conjunctiva and cause the eye to take on a bright red spot.

While this type of eye issue can seem troubling, most cases are often harmless. Subconjunctival hemorrhages do not present with other symptoms or require treatment. Within just two to three weeks, the eye returns to its original state. 

How is Subconjunctival Hemorrhage Diagnosed?

Subconjunctival hemorrhage does not have any associated symptoms, such as pain or swelling. The eye condition only causes a red eye that, at first notice, may prompt an individual to seek medical care and visit an ophthalmology clinic. 

To diagnose a subconjunctival hemorrhage, the ophthalmologist will only need to perform an eye exam.

However, in cases when individuals have recurrent subconjunctival hemorrhages, your ophthalmologist or health care provider may carry out additional actions:

• Ask questions regarding general health and symptoms 
• Check blood pressure 
• Perform a routine blood test to rule out a possible underlying bleeding disorder

What Causes Subconjunctival Hemorrhage?

Subconjunctival hemorrhages can occur due to different causes. 

For example, coughing, sneezing, vomiting, and straining (constipation) can contribute to small blood vessel breakage. These actions, although minor, increase blood pressure in veins briefly, which causes the subconjunctival hemorrhage. 

Other causes that can lead to a subconjunctival hemorrhage include eye injury, eye rubbing, or eye surgery. 

Finally, the following list details some less common causes of the eye condition: 

• Diabetes
• Hypertension (high blood pressure)
• Medicine that causes bleeding easily (e.g., aspirin or blood thinners)

Rarely, a blood clotting disorder or other blood problem that affects the entire body causes the subconjunctival hemorrhage. 

What are the Symptoms of Subconjunctival Hemorrhage?

Again, the subconjunctival hemorrhage will not cause any symptoms. However, individuals with this eye problem will notice a bright red patch on the sclera (white part of the eye). 

In cases of subconjunctival hemorrhage, individuals will not report problems or changes in vision. There will also not be any discharge from the eye or pain. 

If anything, there may be a “scratchy” sensation on the eye’s surface that may produce some discomfort. 

Risk Factors of Recurrent Subconjunctival Hemorrhage

Some individuals may have risk factors that increase their likelihood of recurrent subconjunctival hemorrhages. These risk factors include:

• Diabetes
• Hypertension (high blood pressure)
• Blood-thinning medications, like warfarin (Coumadin and Jantoven)
• Blood-clotting disorders (e.g., hemophilia or von Willebrand disease). 

To lower the risk of broken blood vessels, individuals can take these steps:

• Keep contact lenses clean and maintain good eye care practices
• Wear protective eyewear during sports or in cases where there is flying debris 
• Consult a health care professional if a bleeding disorder is present  

When Should I Call My Healthcare Provider?

It is not common for health complications to occur due to a subconjunctival hemorrhage. However, if an individual has recurrent subconjunctival hemorrhages, it is best to speak with a doctor to rule out all possible causes. 

If an individual develops a hemorrhage because of trauma, a healthcare professional may perform an ocular exam to rule out any other eye complications or injury. Questions that may arise during the examination include:

• When did you first become aware of the problem?
• Are there any other associated symptoms?

Finally, if eye redness comes accompanied by pain, it is important to seek out medical help. This can indicate a more serious, underlying condition, such as hyphema (when blood collects in the eye’s front chamber).

Subconjunctival Hemorrhage in Newborn 

It is quite common for newborns to develop subconjunctival hemorrhages. In many cases, birth deliveries are traumatic. Pressure caused by labor contractions increases blood pressure, so a blood vessel breaks easily. 

Along the same line, when newborns pass through the birth canal, chest compression occurs and raises venous pressure in the head and neck. Babies who have larger chests have an increased risk of blood vessel breakage. 

However, it is important to understand that other causes may lead to subconjunctival hemorrhages in newborns. A pediatrics specialist may therefore perform a differential diagnosis to rule out all other possible medical conditions, including but not limited to:

• Viral infection
• Blunt and penetrating trauma
• Child abuse (e.g., shaken baby syndrome)
• Pertussis (whooping cough)
• HIV 
• Cerebral malaria 

Newborns with higher birth weight face an increased risk of developing a subconjunctival hemorrhage. 

Subconjunctival Hemorrhage Treatment

Subconjunctival hemorrhages do not require any treatment. These tend to go away within two to three weeks, although larger spots may take longer. 

However, individuals may want to take advantage of eyedrops, e.g., artificial tears, to get rid of the “scratchy” sensation in the eye.