Subconjunctival Hemorrhage

Subconjunctival Hemorrhage © 2019 American Academy of Ophthalmology

Subconjunctival Hemorrhage




Subconjunctival Hemorrhage is a bleeding under the conjunctiva of the eye. The white part of the eye is called sclera and conjunctiva is the transparent membrane that covers the sclera. You can’t see the conjunctiva because it is colorless.


What are the Causes of Subconjunctival Hemorrhage


There are blood vessels of different sizes pass under the conjunctiva and for many reasons, tiny small blood vessels will be ruptured and blood is leaking under the conjunctiva. Most of the time, this condition is benign and not associated with underlying diseases.



These are the main causes of Subconjunctival hemorrhage

1- Sudden increase in intravascular pressure

High pressure can cause these vessels to rupture. Increase intravascular pressure can be caused by:

  • Violent Sneezing.
  • Violent Coughing.
  • Straining.
  • Strenuous Exercising and Excessive weight lifting.
  • Vomiting.
  • Choking.
  • Severe Hypertension.

2- Eye trauma

3- Blood dyscrasia

Blood diseases that affect the coagulation status of the body. In this case Subconjunctival Hemorrhage is combined with other systemic or ocular manifestations.

4- Medications

Medications that affect the coagulation status of the body such as Aspirin, warfarin, Heparin, clopidogrel, ticlopidine and dipyridamole.

5- Herbal supplements

Such as ginkgo which can increase the potential for ocular bleeding. Some herbal supplements acts also as a blood thinner such as ginger and garlic.



6- Post Ocular surgery

Many ocular surgeries require manipulation of the conjunctiva such as Lasik eye surgery, cataract surgery and Vitrectomy.

7- Intravitreal Injection

It is common to have it at the site of injection.

8- Ocular Tumor

Kaposi sarcoma can be manifested as Subconjunctival Hemorrhage.

9- Ocular infection

Some bacterial conjunctivitis (S.pneumonia, H.inflenzae) and viral conjunctivitis can be manifested as Subconjunctival Hemorrhage.

10- In infant it can be caused by the above factors and also it can be a sign of Child abuse.


Signs and Symptoms of Subconjunctival Hemorrhage


It is asymptomatic painless condition which means it is associated with no symptoms. Some patients can complain of mild irritation and foreign body sensation but these symptoms are not specific. Vision is not affected. When it is associated or caused by other ocular and systemic diseases, other signs and symptoms can occur.


Treatment of Subconjunctival Hemorrhage


It is a self-limiting condition in which within 2 weeks it will disappear. In the beginning it is bright red in color but with time it will change from red to green and yellow till it disappears completely.

Artificial tears can be used just for non-specific symptoms such as irritation but it will not improve or accelerate the healing. Treatment of any associated underlying conditions.



When to Seek Medical Care

Subconjunctival Hemorrhage itself is not a frightening but sometimes it can be the first sign of other malignant conditions.

You should seek immediate medical care if you have one of these conditions:

1- Severe eye pain.

2- Eye discharge.

3- Subconjunctival Hemorrhage in both eyes.

4- Subconjunctival Haemorrhage that last more than 2 weeks or the one that seems to increase in size with time.

5- Blurred or double vision.

6- Eye floaters or black dots. If you start to see black dots in your vision at the same time with subconjunctival haemorrhage. This means that you might have intraocular hemorrhage.

7- Systemic diseases such as hypertension and blood diseases.

8- On anti-coagulant medications.

9- Trauma to eye or head.

10- Bleeding from other parts of the body such as bleeding Gum.



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