Subconjunctival haemorrhages occur when a small blood vessel within the conjunctiva ruptures, releasing blood into the space between the sclera and the conjunctiva. They often appear after episodes of strenuous activity, such as heavy coughing, weight lifting or straining when constipated. They can also be caused by trauma to the eye.
TOM TIP: Most cases of subconjunctival haemorrhage are idiopathic in otherwise healthy patients. However, several factors may predispose to the condition and are worth assessing:
- Hypertension
- Bleeding disorders (e.g., thrombocytopenia)
- Whooping cough
- Medications (e.g., antiplatelets, DOACs or warfarin)
- Non-accidental injury
Presentation
A subconjunctival haemorrhage appears as a patch of bright red blood underneath the conjunctiva. It covers the white of the eye.
It is painless and does not affect vision. There may be a precipitating event, such as a coughing fit or heavy lifting.
Management
Subconjunctival haemorrhages can be confidently diagnosed based on a simple history and examination. Underlying causes should be considered, for example:
- Checking the blood pressure
- Checking the INR in patients taking warfarin
They are harmless and will resolve spontaneously without treatment, usually in around two weeks. Lubricating eye drops may be helpful if there is mild irritation.
Last updated October 2023