Subconjunctival Hemorrhage: Causes, Symptoms, and Treatment Options

Introduction

Subconjunctival hemorrhage, commonly referred to as a burst blood vessel in the eye, is a frequent and generally harmless condition. It occurs when a small blood vessel breaks just beneath the conjunctiva, the transparent surface of the eye, resulting in a bright red or bloodshot appearance. Although the condition may look concerning, it typically resolves on its own without the need for medical treatment. Historically, subconjunctival hemorrhage has been recognized as benign, though it can occasionally be linked to underlying health issues.

This article aims to help patients better understand subconjunctival hemorrhage, including its risk factors, symptoms, diagnostic tests, treatments, and at-home care options. By providing clear, patient-friendly information, we hope to ease concerns and offer practical advice for managing this condition.

Definition of Subconjunctival Hemorrhage

Subconjunctival hemorrhage occurs when a small blood vessel ruptures beneath the conjunctiva, leading to a red patch on the white part of the eye. This article will explore the risk factors, symptoms, diagnostic tests, medications, procedures, and home care options to help patients manage their symptoms effectively.

Description of Subconjunctival Hemorrhage

Subconjunctival hemorrhage happens when a tiny blood vessel in the eye bursts, causing blood to pool under the conjunctiva, the clear membrane covering the white part of the eye. This results in a visible red or dark patch on the sclera (the white part of the eye). The condition is usually painless and does not affect vision, though its appearance can be unsettling.

Most cases are mild and resolve on their own within one to two weeks. The body gradually absorbs the blood, and the red patch fades without any lasting effects. However, in rare instances, subconjunctival hemorrhage can indicate an underlying medical issue, such as high blood pressure or a bleeding disorder, which may require further investigation.

Subconjunctival hemorrhage is relatively common and can occur spontaneously or due to minor trauma, such as rubbing the eyes too vigorously or straining during activities like coughing, sneezing, or heavy lifting. Studies estimate the prevalence of subconjunctival hemorrhage in the general population to be around 2-3%. While it can happen to anyone, certain risk factors may increase the likelihood of developing this condition.

Risk Factors for Developing Subconjunctival Hemorrhage

Lifestyle Risk Factors

Several lifestyle factors can increase the risk of subconjunctival hemorrhage. Strenuous activities involving heavy lifting or intense physical exertion can raise pressure in the blood vessels, potentially causing them to rupture. Similarly, straining during actions like coughing, sneezing, or vomiting can also elevate the risk.

Other lifestyle factors include smoking and alcohol consumption, both of which can weaken blood vessels over time. Smoking, in particular, is associated with poor vascular health, increasing the likelihood of a blood vessel breaking. Additionally, frequent eye rubbing or wearing contact lenses may heighten the risk due to the potential for minor trauma to the eye.

Medical Risk Factors

Certain medical conditions can predispose individuals to subconjunctival hemorrhage. High blood pressure (hypertension) is one of the most common medical risk factors. Elevated blood pressure places stress on the small blood vessels in the eye, making them more susceptible to rupture. Patients with diabetes may also be at increased risk, as diabetes weakens blood vessels throughout the body, including those in the eyes.

Bleeding disorders, such as hemophilia or thrombocytopenia, can also lead to subconjunctival hemorrhage, as these conditions affect the body’s ability to clot blood properly. Additionally, individuals taking blood-thinning medications, such as aspirin, warfarin, or other anticoagulants, may be more prone to developing subconjunctival hemorrhage due to reduced blood clotting ability.

Genetic and Age-Related Risk Factors

Age is a significant risk factor for subconjunctival hemorrhage. As people age, their blood vessels become more fragile and more likely to rupture. This is particularly true for individuals over 50, who may experience more frequent occurrences as part of the natural aging process.

Genetics can also play a role. Some individuals may have a genetic predisposition to weaker blood vessels or bleeding disorders, increasing the likelihood of developing subconjunctival hemorrhage. Additionally, a family history of hypertension or diabetes may elevate the risk due to underlying vascular issues.

In summary, while subconjunctival hemorrhage is generally benign, understanding the risk factors—whether lifestyle-related, medical, or genetic—can help patients take steps to prevent future occurrences and identify any underlying health concerns that may need attention.

Clinical Manifestations of Subconjunctival Hemorrhage

Red Eye

Red eye is the most common symptom of subconjunctival hemorrhage, occurring in nearly 100% of cases. It happens when small blood vessels break beneath the conjunctiva, creating a bright red or dark patch on the sclera. Although the appearance can be alarming, it is usually painless and does not affect vision. The redness typically resolves on its own within one to two weeks as the blood is gradually reabsorbed by the body.

Eye Irritation

Eye irritation is reported by approximately 20-30% of patients with subconjunctival hemorrhage. This symptom can manifest as mild itching or a gritty sensation, often due to the presence of the blood clot under the conjunctiva. The conjunctiva may become slightly swollen, causing discomfort, though it is usually not severe. Irritation is more noticeable in the early stages and tends to subside as the blood is reabsorbed and the eye heals.

Mild Discomfort

Mild discomfort is experienced by about 15-25% of patients. This sensation is often described as a feeling of pressure or fullness in the eye rather than sharp pain. The discomfort is usually due to the accumulation of blood under the conjunctiva, causing slight swelling. This symptom is more common in larger hemorrhages but generally resolves as the blood is absorbed. Over-the-counter artificial tears can help alleviate any associated dryness or irritation.

Vision Changes

Vision changes are uncommon, occurring in less than 5% of cases. When they do occur, they are usually transient and mild. The blood from the hemorrhage does not typically affect the cornea or the central part of the eye responsible for vision. However, in rare cases where the hemorrhage is extensive, patients may notice slight blurring or a shadow in their peripheral vision. If vision changes persist or worsen, seeking medical attention is essential to rule out more serious eye conditions.

Tearing

Tearing, or excessive watering of the eyes, is reported in about 10-15% of patients with subconjunctival hemorrhage. This symptom can occur as a reflex response to irritation caused by the blood under the conjunctiva. The eye may produce more tears to flush out the perceived foreign body. Tearing usually subsides as the eye heals and the blood is reabsorbed. Artificial tears can help soothe the eye and reduce excessive tearing.

Swelling

Swelling of the conjunctiva, also known as chemosis, occurs in approximately 10-20% of cases. This swelling is caused by the accumulation of blood and fluid under the conjunctiva, leading to a puffy, swollen appearance. The swelling is usually mild and does not cause significant discomfort. It tends to resolve on its own as the blood is reabsorbed. In rare cases, the swelling may be more pronounced, and patients may feel a slight bulging sensation in the eye.

Sensitivity to Light

Sensitivity to light, or photophobia, is a rare symptom, affecting less than 5% of patients with subconjunctival hemorrhage. When it does occur, it is usually mild and temporary. This sensitivity may be due to irritation or inflammation caused by the hemorrhage. Wearing sunglasses or staying in dimly lit environments can help alleviate this symptom. If photophobia persists or is severe, further medical evaluation is recommended to rule out more serious conditions.

Headache

Headaches are reported by about 5-10% of patients with subconjunctival hemorrhage. These headaches are usually mild and may be related to the stress or anxiety caused by the appearance of the red eye rather than the hemorrhage itself. In some cases, the headache may be due to the underlying cause of the hemorrhage, such as high blood pressure. If headaches are severe or persistent, consulting a healthcare provider is important to rule out other causes.

No Pain

One of the hallmark features of subconjunctival hemorrhage is the absence of pain, reported in nearly 100% of cases. Despite the alarming appearance of the red eye, most patients do not experience pain or discomfort. This is because the ruptured blood vessels are located on the eye’s surface, and the hemorrhage does not affect the deeper, more sensitive structures. The lack of pain helps differentiate subconjunctival hemorrhage from other, more serious eye conditions.

No Discharge

No discharge is another characteristic feature of subconjunctival hemorrhage, occurring in nearly 100% of cases. Unlike infections such as conjunctivitis, which can cause sticky or pus-like discharge, subconjunctival hemorrhage does not involve any discharge from the eye. The absence of discharge helps distinguish this condition from other eye issues. If a patient does experience discharge, medical evaluation is important, as this may indicate a coexisting eye infection or another condition.

Diagnostic Evaluation of Subconjunctival Hemorrhage

The diagnosis of subconjunctival hemorrhage is primarily clinical, based on the appearance of the eye and the patient’s history. A healthcare provider will typically perform a physical examination of the eye, looking for the characteristic red patch on the sclera. In most cases, no additional tests are needed, as the condition is usually benign and self-limiting. However, if the hemorrhage is recurrent, extensive, or associated with other concerning symptoms, further diagnostic tests may be recommended to rule out underlying causes such as trauma, high blood pressure, or blood clotting disorders.

Slit-Lamp Examination

A slit-lamp examination is a common diagnostic test used to evaluate the front structures of the eye, including the conjunctiva, cornea, and anterior chamber. During this test, the patient sits in front of a specialized microscope with a bright light, allowing the healthcare provider to examine the eye in detail. The slit-lamp provides a magnified view, making it easier to identify any abnormalities in the eye’s surface or deeper structures. This test is particularly useful in cases of subconjunctival hemorrhage to rule out other conditions, such as corneal abrasions or foreign bodies, that may present with similar symptoms.

Visual Acuity Test

A visual acuity test measures how well a patient can see at various distances. This test involves reading letters or symbols on a chart placed at a specific distance from the patient. The results are recorded as a fraction, with 20/20 vision being considered normal. In the context of subconjunctival hemorrhage, a visual acuity test is important to ensure that the hemorrhage has not affected the patient’s vision. Although subconjunctival hemorrhage typically does not cause vision problems, this test helps rule out other conditions that may be affecting the eye.

Fundoscopy

Fundoscopy, also known as ophthalmoscopy, is a diagnostic test that allows healthcare providers to examine the back of the eye, including the retina, optic nerve, and blood vessels. This test is performed using a handheld device called an ophthalmoscope, which shines a light into the eye and provides a magnified view of the internal structures. Fundoscopy is particularly useful in cases where there is concern about underlying conditions that may affect the eye’s blood vessels, such as hypertension or diabetes, which could contribute to recurrent subconjunctival hemorrhage.

Tonometry

Tonometry is a test that measures the pressure inside the eye, also known as intraocular pressure (IOP). This test is important for detecting conditions such as glaucoma, which can cause increased pressure in the eye and may be associated with subconjunctival hemorrhage in some cases. There are several methods of performing tonometry, including the use of a handheld device that gently presses against the eye or a puff of air that measures the resistance of the eye’s surface. Elevated intraocular pressure can indicate an increased risk of eye damage, which may need to be addressed alongside the subconjunctival hemorrhage.

What if all Tests are Negative but Symptoms Persist?

If all diagnostic tests come back negative but symptoms such as redness or irritation persist, it is important to follow up with your healthcare provider. In some cases, the subconjunctival hemorrhage may take longer to resolve, or there may be an underlying condition that was not initially detected. Your healthcare provider may recommend additional testing or refer you to a specialist, such as an ophthalmologist, for further evaluation. It is essential to monitor your symptoms and report any changes, such as worsening vision or increased discomfort, to ensure appropriate care.

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Treatment Options for Subconjunctival Hemorrhage

Medications for Eye Hemorrhage

Artificial Tears

Artificial tears are over-the-counter eye drops that help lubricate the eye’s surface, often used to relieve dryness and discomfort.

For subconjunctival hemorrhage, they can soothe irritation or mild discomfort caused by the presence of blood. They are typically the first-line treatment for mild cases without pain or vision changes.

While artificial tears provide immediate relief, they do not speed up the healing process. The hemorrhage will naturally resolve within 1 to 2 weeks.

Cold Compresses

Cold compresses involve applying a cool, damp cloth to the affected eye, which can help reduce swelling and irritation.

They are most effective within the first 24 to 48 hours after the hemorrhage occurs. While they don’t directly treat the hemorrhage, they can alleviate surrounding inflammation or discomfort.

Patients can expect temporary relief, but the hemorrhage will still take about two weeks to heal.

Topical Antihistamines

Topical antihistamines are eye drops that reduce itching and irritation caused by allergies or other irritants.

Though not typically used for subconjunctival hemorrhage, they may be recommended if eye allergies are exacerbating symptoms. These drops are often used alongside treatments like artificial tears.

Patients may experience relief from itching within minutes, but the hemorrhage will still take 1 to 2 weeks to heal.

Topical Corticosteroids

Topical corticosteroids are prescription eye drops that reduce inflammation and are often used for more severe eye conditions.

For subconjunctival hemorrhage, they are not a first-line treatment but may be prescribed if significant inflammation is present or if other eye conditions accompany the hemorrhage. These drops should only be used under medical supervision.

Patients may notice reduced inflammation within a few days, but the hemorrhage will still heal naturally.

Oral Analgesics

Oral analgesics, such as acetaminophen or ibuprofen, are used to relieve pain.

For subconjunctival hemorrhage, non-aspirin pain relievers are preferred to avoid worsening the condition. Analgesics may be recommended if discomfort or mild pain is present.

Pain relief typically occurs within 30 minutes to an hour, but the hemorrhage itself remains unaffected by these medications.

Vitamin K

Vitamin K is essential for blood clotting and may be used to address bleeding disorders.

In rare cases, a subconjunctival hemorrhage caused by a vitamin K deficiency may require supplementation. This treatment is uncommon unless a clotting disorder or deficiency is diagnosed.

Patients can expect improved blood clotting over time, but this treatment is reserved for specific cases.

Anticoagulant Reversal Agents

Anticoagulant reversal agents counteract the effects of blood thinners like warfarin or heparin.

If a subconjunctival hemorrhage results from excessive anticoagulation, a healthcare provider may recommend stopping the anticoagulant or using a reversal agent. This is typically reserved for more severe cases with persistent or recurrent bleeding.

Once anticoagulation is reversed, the bleeding should stop, but the hemorrhage will still need time to heal.

Antibiotic Eye Drops

Antibiotic eye drops are used to treat bacterial infections in the eye.

While subconjunctival hemorrhage is not caused by infection, antibiotics may be prescribed if an infection is present or if the hemorrhage is accompanied by signs of infection, such as discharge or significant redness.

The infection should clear within a few days, but the hemorrhage will heal on its own.

Lubricating Ointments

Lubricating ointments are thicker than artificial tears and provide longer-lasting moisture.

These ointments are often used at night to keep the eyes moist, especially if dryness or irritation is present. While not a direct treatment for subconjunctival hemorrhage, they can relieve discomfort.

Patients can expect relief from dryness, but the hemorrhage will still heal naturally over 1 to 2 weeks.

Improving Subconjunctival Hemorrhage and When to Seek Medical Help

Most cases of subconjunctival hemorrhage resolve without medical intervention, but several home remedies can improve comfort and support healing:

1. Resting the eyes: Avoid activities that strain the eyes, such as reading or extended screen time, to reduce irritation.
2. Applying a cold compress: This can help reduce swelling or discomfort within the first 24 to 48 hours.
3. Keeping the head elevated: Elevating the head, especially while sleeping, can reduce eye pressure.
4. Staying hydrated: Drinking plenty of water supports overall eye health and may aid in the healing process.
5. Reducing salt intake: Lowering salt consumption can help prevent fluid retention, which may reduce eye pressure.
6. Wearing sunglasses: Protect your eyes from bright light or irritants to prevent further discomfort.
7. Using artificial tears: These help keep the eyes moist and reduce irritation.
8. Monitoring for changes in vision: Seek medical attention immediately if you notice vision changes, such as blurriness or loss of sight.

While subconjunctival hemorrhage usually resolves on its own, recurring episodes, pain, or vision changes warrant medical attention. Telemedicine offers a convenient way to consult with a healthcare provider without needing to visit a clinic. This is especially useful for conditions like subconjunctival hemorrhage, where a visual inspection and discussion of symptoms may suffice for diagnosis and treatment recommendations.

Living with Subconjunctival Hemorrhage: Tips for Better Quality of Life

Living with a subconjunctival hemorrhage can be concerning, especially if it’s your first experience. However, several steps can improve your quality of life while your eye heals:

1. Use artificial tears to keep your eyes comfortable and reduce irritation.
2. Wear sunglasses to protect your eyes from bright lights and environmental irritants.
3. Rest your eyes frequently, especially if you work on a computer or engage in activities that strain your eyes.
4. Stay hydrated and maintain a balanced diet to support overall eye health.
5. Avoid rubbing your eyes, as this can worsen the condition or cause further irritation.

By following these tips, you can manage the symptoms of subconjunctival hemorrhage while your body naturally heals the affected area.

Conclusion

Subconjunctival hemorrhage is a common, generally harmless condition that occurs when a small blood vessel breaks under the eye’s surface. Though it may look alarming, it usually resolves on its own within 1 to 2 weeks without medical treatment.

Early diagnosis and proper management can ensure no underlying conditions contribute to the hemorrhage. If you experience recurring episodes, pain, or vision changes, seek medical advice promptly.

Our telemedicine practice offers a convenient way to consult with a healthcare provider from the comfort of your home. If you’re concerned about a subconjunctival hemorrhage or any other eye condition, don’t hesitate to reach out for a consultation today.

James Kingsley

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