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Subconjunctival Hemorrhage
Article Last Updated: Aug 24, 2006
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Coauthor(s):
Vivian Monsanto, MD, Consulting Staff, The Mackool Eye Institute and Laser Center;
Norvin Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine; Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center
Editors: Kilbourn Gordon III, MD, FACEP, Urgent Care Physician, Primary Medical, Huntington Walk-In and Greenwich Convenient Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida; Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Author and Editor Disclosure
Synonyms and related keywords:
red eye, bleeding in eye, blood in eye
Background
Subconjunctival hemorrhage is defined as blood between the conjunctiva and the sclera, and it is involved in the differential diagnosis of a red eye.
Pathophysiology
Subconjunctival hemorrhage results from bleeding of the conjunctival or the episcleral blood vessels into the subconjunctival space. The hemorrhage can be traumatic, spontaneous, or related to systemic illness.
Frequency
United States
This condition occurs frequently. Exact figures are unknown because it is a self-limited disorder.
Mortality/Morbidity
Subconjunctival hemorrhage is a self-limited condition when not associated with systemic illness.
Race
No racial preference for subconjunctival hemorrhage is evident.
Sex
No gender difference for subconjunctival hemorrhage is evident.
Age
Subconjunctival hemorrhage can occur at all ages, but it is more common with increasing age.
History
- Red eye
- May have mild irritation
- Usually asymptomatic
Physical
- Most common appearance is a bright red patch with relatively normal surrounding.
- Slit lamp examination shows its precise location under the conjunctiva.
- View of sclera may be obscured by blood. If thick, it may be dark red.
Causes
- Idiopathic
- Valsalva (eg, coughing, straining)
- Traumatic (isolated or associated with retrobulbar hemorrhage or ruptured globe)
- Hypertension/arteriosclerosis
- Bleeding disorders (if recurrent or in young patients without history of trauma or infection), including hematologic or hepatic disease, diabetes, systemic lupus erythematosus, parasites, and vitamin C deficiency
- Various antibiotics, drugs/chemicals (eg, coumadin, nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin), steroids, contraceptives, and vitamins A and D have been associated with subconjunctival hemorrhage.
- Normal sequelae of ocular surgery even if no conjunctival incision
- Several febrile systemic infections can cause subconjunctival hemorrhage, including meningococcal septicemia, scarlet fever, typhoid fever, cholera, rickettsia, malaria, and viruses (eg, influenza, smallpox, measles, yellow fever, sandfly fever).
- Subconjunctival hemorrhage has been reported as a result of emboli from long bone fractures, chest compression, cardiac angiography, open-heart surgery, and other remote operations.
Conjunctivitis, Acute Hemorrhagic
Red Eye Evaluation
Other Problems to be Considered
Kaposi sarcoma
Other conjunctival neoplasms with secondary hemorrhage
Lab Studies
- Usually, no laboratory studies are indicated.
- Check blood pressure.
- If history of trauma, rule out ruptured globe or retrobulbar hemorrhage.
- In recurrent cases or if history of bleeding problems (eg, epistaxis, easy bruising), a bleeding time, prothrombin time/activated partial thromboplastin time (PT/aPTT), CBC with platelets, and protein C and S should be obtained with consideration for consultation to an internist.
Medical Care
Medical care is not required.
- Artificial tears can be used 4 times per day for mild irritation.
- Discourage elective use of aspirin products or NSAIDs.
Consultations
Referral to an internist or family physician should be made as indicated for hypertension or bleeding diathesis.
Medications are not indicated for this condition.
Further Outpatient Care
- With time and blood breakdown, hemorrhage may become green or yellow, like a bruise, spreading around the circumference of the globe. Usually, this disappears within 2 weeks.
- Patients are told to return if blood does not fully resolve or if they have a recurrence.
Prognosis
Patient Education
Special Concerns
- Occurrence of subconjunctival hemorrhage in an eye after scleral buckle indicates buckle infection until proven otherwise even if the surgery was performed years before. Usually, there is focal tenderness somewhere over the buckle.
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Subconjunctival Hemorrhage excerpt Article Last Updated: Aug 24, 2006
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