Subconjunctival Haemorrhage

Subconjunctival haemorrhages are a relatively common condition where one of the small blood vessels within the conjunctiva ruptures and release 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. It can also be caused by trauma to the eye.

TOM TIP: Most cases are idiopathic and the patient is otherwise healthy, however there are a number of conditions that may have predisposed them to developing a subconjunctival haemorrhage. When a patient turns up with a subconjunctival haemorrhage use it as a clue to think about other conditions that may have contributed:

  • Hypertension
  • Bleeding disorders (e.g thrombocytopenia)
  • Whooping cough
  • Medications (warfarin, NOACs, antiplatelets)
  • Non-accidental injury

 

Presentation

A subconjunctival haemorrhage appears as a patch of bright red blood underneath the conjunctiva and in front of the sclera covering the white of the eye. It is painless and does not affect vision.

There may be a history of a precipitating event such as a coughing fit or heavy lifting.

They can be confidently diagnosed based on a simple history and examination.

 

Management

Subconjunctival haemorrhages are harmless and will resolve spontaneously without any treatment. This usually takes around 2 weeks.

Think about the possible causes such as hypertension and bleeding disorders. These may need investigating further.

If there is a foreign body sensation lubricating eye drops can help with symptoms.

 

Last updated April 2019
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