Subconjunctival Hemorrhage

Subconjunctival Hemorrhage

Article
Eye & Vision
Diseases & Conditions
+2
Contributed byKrish Tangella MD, MBAAug 14, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • Hyposphagma
  • Popped Blood Vessel in the Eye
  • Subconjunctival Haemorrhage

What is Subconjunctival Hemorrhage? (Definition/Background Information)

  • Subconjunctival Hemorrhage is a condition in which a blood vessel in the front part of the eye breaks, causing small amounts of blood to leak underneath the conjunctiva (the white part of the eye)
  • The condition may occur due to a sudden increase in pressure that can be brought about by a sudden and intense fit of coughing, sneezing, vomiting, heavy-lifting, and straining to pass stools. The risk is higher in individuals who have high blood pressure
  • Trauma and surgery to the eye may also cause a blood vessel in the front part of the eye to burst, causing blood to leak. Subconjunctival Hemorrhage may also arise spontaneously
  • The signs and symptoms of Subconjunctival Hemorrhage are almost always worse, or more alarming, than the actual damage. If a small amount of blood leaks from the broken blood vessel, it usually smears the eye, causing the appearance of a severe red eye
  • The red eye usually lasts 2-4 weeks before resolving on its own. Hence, Subconjunctival Hemorrhage usually does not require any treatment interventions. If required, eye creams and ointments may be used to provide a measure of comfort. The outcome is generally excellent with adequate care

Who gets Subconjunctival Hemorrhage? (Age and Sex Distribution)

  • Subconjunctival Hemorrhage occurs without any age and gender, racial and ethnic group, or geographical predilection
  • However, the condition is more frequent in individuals who had had a recent trauma, eye surgery, or those with high blood pressure (hypertension)
  • Since elderly individuals are more likely to be taking blood thinners (a type of medication), the likelihood of Subconjunctival Hemorrhage is higher in this age group

What are the Risk Factors for Subconjunctival Hemorrhage? (Predisposing Factors)

The risk factors for developing Subconjunctival Hemorrhage include:

  • Use of blood-thinning medications
  • Recent trauma, injury, or surgery to the eye
  • Constipation: Straining to pass stools may increase the pressure inside the blood vessels in the front of the eye, causing them to rupture
  • Poorly-controlled high blood pressure: If the pressure inside a blood vessel gets too high, the blood vessel may rupture, causing bleeding in the front part of the eye
  • Poorly-controlled diabetes causes one to bleed more easily
  • Clotting disorders: Such disorders cause easy bleeding (anywhere in the body), and therefore increase the risk for developing a hemorrhage in the white part of the eye

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Subconjunctival Hemorrhage? (Etiology)

The following are the known causes of Subconjunctival Hemorrhage:

  • Any injury or trauma or surgery to the eye: During eye surgery, a clamp is usually used to hold the eyelids open. The pressure from the clamp often causes a blood vessel in the front of the eye to burst
  • Heavy coughing, sneezing, or vomiting may lead to sudden increase in pressure, causing a rupture in the eye blood vessels
  • Heavy lifting: Straining from lifting heavy objects may cause a popped blood vessel in the eye
  • Rough rubbing of the eye: Too much force for rubbing the eyes roughly may cause a broken blood vessel
  • High blood pressure that is not properly controlled, may result in rupture of blood vessels
  • Blood thinner use: Blood thinning medications administered for various purposes prevents clotting in blood vessels, making it easier for blood to leak from a blood vessel and smear the eye
  • Poorly-controlled diabetes, which can cause bleeding
  • Viral infections that may cause hemorrhages
  • Disorders that affect blood clotting

What are the Signs and Symptoms of Subconjunctival Hemorrhage?

Subconjunctival Hemorrhage may often be asymptomatic. If signs and symptoms do occur, they may include:

  • Moderate to severe red eye, usually in one section of the white part of the eye
  • Bleeding in the front part of the eye that may turn yellowish in color due to bruising
  • Mild eye irritation
  • Mild scratchy feeling on the front of the eye

How is Subconjunctival Hemorrhage Diagnosed?

The diagnosis of Subconjunctival Hemorrhage is made on the basis of the following tests and exams:

  • Complete physical examination including eye examination
  • Obtaining a thorough medical history, including assessment of any recent trauma, eye surgery, heavy-lifting, coughing, presence of pre-existing conditions, such as diabetes, or blood thinner medication use for high blood pressure
  • Examination of smeared blood under the tissue that covers the white part of the eye, by an eye specialist
  • History of previous occurrences of Subconjunctival Hemorrhage

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Subconjunctival Hemorrhage?

Complications due to Subconjunctival Hemorrhage can include:

  • Failure to resolve in a timely manner, if an underlying clotting disorder exists
  • Cosmetically unappealing red eye that may last for 2-3 weeks
  • Emotional stress and worries

How is Subconjunctival Hemorrhage Treated?

Subconjunctival Hemorrhage typically resolves on its own without any treatment intervention. However, if treatment is sought or necessary, the following may be recommended:

  • Artificial tears, lubricating gels, and lubricating ointments to help soothe the eye, although these products will not help repair the broken blood vessel directly
  • Avoidance of heavy-lifting, to prevent further bleeding
  • Avoidance of rubbing the eye, to prevent blood in the eye from smearing
  • Temporary discontinuation of elective blood thinners, such as aspirin and omega 3s, under the supervision of a healthcare provider

How can Subconjunctival Hemorrhage be Prevented?

Preventive methods for Subconjunctival Hemorrhage include the following:

  • Management of systemic conditions such as diabetes or high blood pressure (hypertension)
  • Conscious avoidance of straining too hard if constipated, or while lifting heavy objects
  • Being cautious about consuming Omega 3 supplements, if one is already taking blood thinners, as these supplements may have an additive effect of poor blood clotting
  • If Subconjunctival Hemorrhage occurs frequently, one should discuss with the healthcare provider about altering dosages of blood thinning medications

What is the Prognosis of Subconjunctival Hemorrhage? (Outcomes/Resolutions)

  • The prognosis of Subconjunctival Hemorrhage is usually excellent, since the condition typically resolves on its own. Subconjunctival Hemorrhage is not considered a serious condition
  • However, if the condition lasts for more than a few weeks or recurs on several occasions, there may be an underlying clotting disorder that needs to be brought to the attention of one’s healthcare provider and addressed accordingly

Additional and Relevant Useful Information for Subconjunctival Hemorrhage:

  • Although Subconjunctival Hemorrhage is not a serious condition, it accounts for one of the most common types of ocular emergency visits due to its presentation of a severe red eye
  • A severe red eye should always be seen by a healthcare professional, to rule out other more serious conditions
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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