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The eye is covered by the conjunctiva, a transparent tissue. A subconjunctival hemorrhage occurs when blood collects under this tissue.
The conjunctiva and the space between the sclera and conjunctiva have multiple tiny blood vessels. These can burst, resulting in the hemorrhage.
Many people do not experience symptoms outside of the visible redness of the affected eye.
Many things can cause this type of hemorrhage, including injuries, eye infections, and certain medications.
If the cause is known, further diagnostic testing outside of a visual examination is usually not necessary. However, the doctor may do more testing if the person has other symptoms that are curious, such as recent unusual bleeding or bruising.
Treatment is not always necessary though in some cases subconjunctival hemorrhage eye drops, in the form of artificial tears, may be used. If the hemorrhage is due to an underlying disorder, treatment might be needed to get the condition under control.
What Is a Subconjunctival Hemorrhage?
When something causes blood vessels to leak into the conjunctiva, this condition can occur. In most cases, it is benign.
In one study with 8,726 participants, subconjunctival hemorrhage was observed at a rate of 2.9 percent. The issue is more prevalent as people get older. Most people fully recover from subconjunctival hemorrhage on their own without treatment.
Certain medical conditions may cause bleeding that could put someone at risk for developing this hemorrhage. Examples of these conditions include high blood pressure, disorders that affect blood clotting, and diabetes.
When this hemorrhage occurs, there is a bright red spot on the white part of the eye. This issue usually does not cause any vision changes to the eye.
It also typically does not cause any pain or eye discharge. It is possible to feel a scratchiness on the surface of the eye.
Causes & Risk Factors
The cause of this condition is not always something doctors can identify. It could be due to:
- Trauma. When blunt force strikes the eye, it could cause a blood vessel to burst, resulting in the hemorrhage.
- Blood pressure changes. If blood pressure increases suddenly, it could result in this hemorrhage. This could happen due to a medical issue or situations like heavy lifting, sneezing, constipation (when someone strains to have a bowel movement), coughing, or laughing.
- Medications. Certain medications can thin the blood, making bleeding and bruising easier. Examples include warfarin or aspirin. People might take these medications if they have a clotting disorder.
- Vitamin K deficiency. While rare, if someone is deficient in vitamin K, they are at risk for this hemorrhage. This is because this vitamin is essential for the functioning of certain proteins that the body requires to clot the blood.
- Eye surgery. People who have certain types of eye surgery are at risk for this hemorrhage as a potential surgical complication. Surgery examples include cataract surgery and LASIK.
- Infection. It is possible for certain eye infections to cause this hemorrhage. The most common infection of the eye is conjunctivitis. In addition to the hemorrhage, the following symptoms may also be present:
- Eye redness
- Gritty feeling in the eye
- Eye itchiness
- Eye discharge
Getting an Accurate Diagnosis
The diagnostic process might be done to determine if there is an underlying cause that resulted in this hemorrhage. To diagnose the actual hemorrhage, the doctor only needs to look at the eye.
If someone has recurrent episodes of this hemorrhage, further testing may be considered to see what could be causing it. The following tests could be performed:
- A complete physical examination to learn more about overall health
- Checking blood pressure
- Doing an eye examination to see if there are any underlying eye disorders
- Blood work to check vitamin K levels or to look for potential bleeding disorders
In many cases, this hemorrhage will resolve on its own and people will not need to have any specific treatment for it.
During the healing phase, the person should keep an eye on the recovery progress. If the hemorrhage does not get better or if it worsens, they should contact their doctor right away.
If someone experiences eye irritation with their hemorrhage, the doctor might prescribe artificial tears as subconjunctival hemorrhage eye drops. It is imperative to follow the usage instructions exactly to reduce the irritation. People should use great care when applying subconjunctival hemorrhage eye drops and never allow the applicator to touch the eye.
If people start to experience pain with their hemorrhage, they should alert their doctor right away. This could indicate hyphema or another more serious condition.
When someone has a hyphema, blood collects at the front of the eye between the iris and the cornea. This is usually the result of a pupil or iris injury. Without proper treatment, it is possible to experience permanent vision issues.
If a bleeding disorder or high blood pressure is responsible for this hemorrhage, the doctor will often provide treatment for these conditions. If someone has a bleeding disorder, the doctor may prescribe a medication to reduce bleeding risk. In some cases, blood, clotting factor, and platelet transfusions can be beneficial.
A normal blood pressure reading is said to be below 120/80. If someone has a reading that exceeds these numbers, the doctor will likely talk to them about methods to bring it down. The following are common ways to work toward lower blood pressure:
- Lose excess weight or maintain a healthy weight.
- Eat a diet of mostly nutritious foods.
- Get exercise most days of the week (about 30 minutes per day).
- Reduce alcohol intake.
- Take prescribed blood pressure medications.
- Don’t smoke cigarettes.
- Reduce salt intake.
If someone is taking blood thinners, the doctor may advise that they stop taking them, or they may alter the dosage. However, it is important that no one ever stop taking these medications without doctor supervision.
Subconjunctival Hemorrhage vs. Red Eye
Since a subconjunctival hemorrhage is actual blood in the conjunctiva, it tends to look more intense than common cases of red eyes, such as those caused by allergies or other irritations.
If your eyes are bloodshot because of allergies, fatigue, too much screen time, or another issue, they tend to be a lighter red and the redness is often diffused throughout the entire eye. With a subconjunctival hemorrhage, there is usually a concentrated area of intense redness that looks like blood.
There is usually no pain associated with a subconjunctival hemorrhage, but there may be irritation or discomfort associated with other types of red eye. For example, your eyes might feel itchy and irritated if they are red due to allergies.
Outlook and Prevention
It takes approximately 7 to 14 days for this hemorrhage to resolve. It usually requires no treatment for it to clear up.
While prevention is not always possible, taking care of the eyes and avoiding situations where eye trauma is possible are beneficial steps to take. Wear protective goggles when necessary, and always flush the eye properly should something get into it.
People who have conditions that can cause a hemorrhage should follow the treatments their doctor prescribes. Those taking blood thinners should alert their doctor if they notice any unusual bleeding or bruising.
Looking in the mirror to see a subconjunctival hemorrhage can be scary, but in many cases, this is a benign condition. However, if trauma caused it or it lasts more than two days, seeing a doctor is a good idea. There could be an underlying cause that requires treatment.
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