Subconjunctival Hemorrhage

Dr Ben Wild

Overview

The front of the eye, excluding the cornea, is composed of the sclera (white part of the eye with large and strong blood vessels), a layer called the episclera (a clear layer above the sclera with many small and delicate blood vessels), and the conjunctiva (another clear layer again with delicate blood vessels).

Frontal view of a healthy eye.

Subconjunctival hemorrhages occur when one of these small, delicate, blood vessels in the episclera or conjunctiva rupture and leak blood into the spaces between the aforementioned layers. These hemorrhages are very common occurrences but usually appear as emergencies because of their frightening appearance. If the affected person has a platelet deficiency or is on a blood thinner, the time between rupture and closure of the rupture is extended and more blood seeps into the subconjunctival space. Enough blood can enter this space to completely cover the sclera.

Frontal view of an eye with a subconjunctival hemorrhage.

Subconjunctival hemorrhages are most common after eye surgery, after conjunctivitis, post-trauma, post Valsalva maneuver (coughing, vomiting, difficult time on the toilet, heavy lifting, etc.), but is usually idiopathic (no known cause). They are usually asymptomatic but again, appear very cosmetically concerning. Rarely, one may feel a split second of sharp pain as the blood vessel ruptures. If there is enough swelling, the cornea can cause irritation and decreased vision.

In infants, it may be a vitamin C deficiency, in young patients it is usually associated with contact lens wear and in the elderly, it is most commonly associated with high blood pressure.

Signs and Symptoms

Signs

Blood seeping into subconjunctival space over the underlying white sclera.

Symptoms

Usually no symptoms, sometimes a split second of sharp pain when the vessel pops, if very swollen, can cause blurry vision and ocular irritation.

Causes and Risk Factors

Causes

Post ocular surgery, post conjunctivitis, post trauma, post Valsalva maneuver but usually idiopathic.

Risk Factors

Vitamic C deficiency in infants, contact lens wear in young adults, high blood pressure in elderly.

Prevention and Treatment

Prevention

Handle contact lens insertion and removal carefully, avoid high blood pressure.

Treatments

· Resolves without treatment like a bruise.

· Artificial tears if irritating.

Prognosis

Subconjunctival hemorrhages are very common and look much worse than their reality. They usually do not require any treatment or investigation. They are not vision threatening but may be caused by underlying health conditions if recurrent in nature. It is important seek diagnoses and treatment for the underlying conditions.