Subconjunctival hemorrhage: Will You Need Tests?

Subconjunctival hemorrhage Overview

A subconjunctival hemorrhage (sub-kun-JUNK-tih-vul HEM-uh-ruj) occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva).

You may not realize you have a subconjunctival hemorrhage until you look in the mirror and find the white part of your eye is bright red.

The conjunctiva can’t absorb the blood very quickly, so the blood is trapped under this transparent surface. A subconjunctival hemorrhage may worry you, but it’s usually a harmless condition that disappears within one or two weeks.

Subconjunctival hemorrhage often occurs without any obvious harm to your eye, or it may be the result of a strong sneeze or cough that caused a blood vessel to break. You don’t need any specific treatment for a subconjunctival hemorrhage.

Subconjunctival Hemorrhage facts

The conjunctiva is the thin, moist, transparent membrane that covers the white part of the eye (called the sclera) and the inside of the eyelids. The conjunctiva is the outermost protective coating of the eyeball.

The conjunctiva contains nerves and many small blood vessels. These blood vessels are usually barely visible but become larger and more visible if the eye is inflamed. These blood vessels are somewhat fragile and their walls may break easily, resulting in a subconjunctival hemorrhage (bleeding under the conjunctiva). A subconjunctival hemorrhage appears as a bright red or dark red patch on the sclera.

Symptoms and Causes of a Broken Blood Vessel on the Front of the Eye

Besides the visible bleeding between the sclera (the white part of the eye) and conjunctiva, many people describe a scratchy or itchy feeling on the surface of the eye. Pain is generally non-existent or minimal, and there is no change in vision, although there may be some discomfort.

The conjunctiva contains several nerves and tiny blood vessels. These blood vessels (which are barely visible until they become inflamed and enlarged) are fragile, and their walls can easily break. Events that can cause blood vessels on the front of the eye to break include:

• Sneezing
• Coughing
• Vomiting
• Straining
• Poorly controlled blood pressure
• Crying
• Rubbing your eyes
• Blunt trauma
• Increased intracranial or intraocular pressure
• Shaken baby syndrome (often the case in children with subconjunctival hemorrhages in both eyes)

This is not an exhaustive list; often the exact cause of the injury is unknown. There are several factors that can increase the risk of a broken blood vessel on the front of the eye. For example, medications and supplements such as warfarin, aspirin, Plavix, and high doses of vitamin E can thin the blood and make it easier for hemorrhages to occur. Although rare, St. John’s wort, ginkgo biloba, ginger, and cayenne can also increase one’s risk if taken in high doses. Occasionally, blood vessels on the front of the eye will break due to conjunctivitis (eye infection) and high blood pressure.

What are the Risk Factors for Subconjunctival Bleeding?

Bleeding under the conjunctiva is a common condition that can occur at any age. It is thought to be equally common in both sexes and all races. The risk of experiencing this kind of bleeding increases as you get older. If you have a bleeding disorder, or if you take drugs to thin your blood, you may have a slightly higher risk.

Risk factors for subconjunctival hemorrhage include:

• Diabetes
• High blood pressure (hypertension)
• Certain blood-thinning medications, such as warfarin (Coumadin) and aspirin
• Blood-clotting disorders

Subconjunctival Hemorrhage Complications

Although you may feel self-conscious about the appearance of your eye, health complications from a subconjunctival hemorrhage are rare. If your condition is due to trauma, your doctor may evaluate your eye to ensure you don’t have other eye complications or injury.

How is it Diagnosed? Will You Need Tests?

It is important to tell your doctor if you have recently experienced any unusual bruising or bleeding, or any injuries, such as a foreign object in your eye.

Most often, if you have bleeding under your conjunctiva you will not need any tests. Your doctor will inspect your eye and check your blood pressure. In some cases, you may be asked to give a blood sample to test for any bleeding disorders. This is more likely if you have had more than one episode of bleeding under the conjunctiva, or if you have experienced other odd hemorrhages or bruises.

Treatment of a Broken Blood Vessel in the Eye

In most cases, treatment is not needed for a subconjunctival hemorrhage. If you are experiencing pain or discomfort, over-the-counter pain medications such as Tylenol may be recommended. Aspirin and related products should be avoided due to their blood-thinning side effects. Those who take aspirin or anticoagulants for a medical condition should talk with their eye doctor to determine whether it is safe to continue using these during the healing process. Over-the-counter artificial tears may also help reduce any irritation. If the subconjunctival hemorrhage is due to trauma, other treatment may be necessary to promote healing. If an infection is present, antibiotic eye drops or ointment may be prescribed. Typically, the condition clears up on its own within two or three weeks, without long-term problems.