Introduction  

A subconjunctival hemorrhage arises from the breakage of blood vessels situated under the transparent surface of the eye (conjunctiva). Since the conjunctiva cannot take in blood quickly, the blood accumulates, and as a result, the bright part of the eye turns bright red.
The conjunctiva refers to the transparent membrane that covers the white section of the eye (sclera) and inside the eyelids. It is the external protective covering of the eyeball which contains blood vessels and nerves. These blood vessels are hardly visible until the eye is inflamed at which point they are larger and far more visible.
Subconjunctival bleeding is common among the elderly where it occurs spontaneously or due to minor trauma. They resolve without treatment within a few days. In some cases, recurrent hemorrhages suggest an underlying condition such as a coagulation disorder or hypertension. 

Also Known As

Subconjunctival bleeding

Sub-Types

 

Causes and Risk Factors

The primary cause of subconjunctival bleeding is not apparent. However, some of the actions that could cause the blood vessels in the eye to rupture are:

  • Straining
  • Ebola
  • LASIK
  • Choking
  • Vomiting
  • Leptospirosis
  • Zygoma fracture
  • Powerful sneezing
  • Rubbing the eye roughly
  • Trauma to the eye
  • Coagulation disorder
  • Increased venous pressure
  • Acute hemorrhagic conjunctivitis
  • Vitamin C deficiency or asphyxia syndrome in children
  • Violent coughing like in cases where a person is suffering from whooping cough 
  • Mask squeeze arising from diving without equalizing mask pressure
  • Infections affecting the external part of the eye where a bacteria or virus attacks the walls of the blood vessels surrounding the conjunctiva

The risk factors for subconjunctival hemorrhage are:

  • Diabetes
  • Use of contact lenses
  • Old age
  • High blood pressure (hypertension)
  • Blood clotting disorders
  • Blood-thinning medications like aspirin and warfarin (Jantoven, Coumadin)
  • A disease characterized by a decrease in platelet count
     

Signs & Symptoms

The most obvious sign that a person has conjunctival hemorrhage is a red patch on the white part of the eye. Subconjunctival bleeding does not cause any change in one's vision. It does not cause pain or discharge from the eye. The only discomfort is a scratchy sensation on the eye surface.

Diagnosis

The eye care professional will diagnose subconjunctival hemorrhage by examining the patient’s eye. If one is dealing with a case of recurrent subconjunctival hemorrhage, the eye care professional may also:

  • Ask questions about the patient’s health and symptoms
  • Perform an eye examination using a slit lamp
  • Take the patient’s blood pressure
  • Perform a blood test to check whether it is a severe bleeding condition
     

Treatment 

Treatment for subconjunctival hemorrhage is focused on stopping the bleeding in the eye.

Medical Treatment

While many cases of subconjunctival hemorrhage heal on their own, in some cases the eye doctor may recommend artificial tears.
If an external infection causes the subconjunctival hemorrhage, the doctor may prescribe an ointment or antibiotic drops.

Prognosis/Long-term outlook

It is rare to experience complications with subconjunctival hemorrhage. However, if a patient takes aspirin or blood thinners such as warfarin, they may experience increased bleeding.
This condition goes away by itself within a week or two. Recovery usually is complete without long term problems the same way a mild skin bruise heals. Similar to a bruise, subconjunctival bleeding changes colors during the healing process. The transparency of the conjunctiva makes these color characteristics invisible.

Prevention/Follow Up

To prevent the development of subconjunctival bleeding, a person should avoid rubbing their eyes violently. Rubbing the eyes forcibly causes trauma which leads to subconjunctival hemorrhage. 
Some people may not be in a position to stop taking blood thinners. In such such cases, the use of phenylephrine can minimize the risk of getting subconjunctival hemorrhage. Another option is the use of brimonidine. According to a study by the Journal of Refractive Surgery, brimonidine can help prevent the occurrence of subconjunctival hemorrhage. 
The other preventive measure may be to avoid undergoing LASIK surgery altogether. Avoiding contact lenses which put pressure on the conjunctiva may also reduce trauma or injury which increases the risk of subconjunctival hemorrhage.