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Subconjunctival Hemorrhage Author Information

Last Updated: August 24, 2006 Introduction
Synonyms and Clinical
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red eye, bleeding in Workup
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Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, images.
Scottsdale, Arizona
Coauthor(s): Vivian Monsanto, MD, Consulting Staff, The Mackool Eye Institute and Laser Center; Norvin
Perez, MD, Clinical Assistant Professor of Emergency Medicine, Albert Einstein College of Medicine;
Consulting Staff, Department of Emergency Medicine, Montefiore Medical Center Related Articles
Robert H Graham, MD, is a member of the following medical societies: American Academy of Conjunctivitis,
Ophthalmology, American Medical Association, and Arizona Ophthalmology Society Acute Hemorrhagic
Editor(s): Kilbourn Gordon III, MD, Scientific Director, Foresight Ventures; Francisco Talavera, PharmD,
PhD, Senior Pharmacy Editor, eMedicine; J James Rowsey, MD, Medical Staff Appointment, Department of Red Eye Evaluation
Surgery, Division of Ophthalmology, All Children's Hospital, St Petersburg, Director of Corneal Services, St
Luke's Cataract and Intraocular Lens Institute; Lance L Brown, OD, MD, Ophthalmologist, Regional Eye
Center, Affiliated With Freeman Hospital and St John's Hospital, Joplin, Missouri; and Hampton Roy, Sr, Patient Education
MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical
Eye and Vision
Sciences Center

Subconjunctival
Disclosure Hemorrhage
Overview

Subconjunctival
Hemorrhage
 Causes

Subconjunctival
Hemorrhage
Symptoms

Subconjunctival
Hemorrhage
INTRODUCTION Section 2 of 10 Treatment
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Black Eye Overview

Background: Subconjunctival hemorrhage is defined as blood between the conjunctiva and the sclera, and it
is involved in the differential diagnosis of a red eye.

Pathophysiology: Subconjunctival hemorrhage results from bleeding of the conjunctival or the episcleral
blood vessels into the subconjunctival space. The hemorrhage can be traumatic, spontaneous, or related to
systemic illness.

Frequency:

 In the US: This condition occurs frequently. Exact figures are unknown because it is a self-limited
disorder.

Mortality/Morbidity: Subconjunctival hemorrhage is a self-limited condition when not associated with

systemic illness.

Race: No racial preference for subconjunctival hemorrhage is evident.

Sex: No gender difference for subconjunctival hemorrhage is evident.

Age: Subconjunctival hemorrhage can occur at all ages, but it is more common with increasing age.
 CLINICAL Section 3 of 10
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History:

 Red eye

 May have mild irritation

 Usually asymptomatic

Physical:

 Most common appearance is a bright red patch with relatively normal surrounding.

 Slit lamp examination shows its precise location under the conjunctiva.

 View of sclera may be obscured by blood. If thick, it may be dark red.

Causes:

 Idiopathic

 Valsalva (eg, coughing, straining)

 Traumatic (isolated or associated with retrobulbar hemorrhage or ruptured globe)

 Hypertension/arteriosclerosis

 Bleeding disorders (if recurrent or in young patients without history of trauma or infection), including
hematologic or hepatic disease, diabetes, systemic lupus erythematosus, parasites, and vitamin C
 deficiency

 Various antibiotics, drugs/chemicals (eg, coumadin, nonsteroidal anti-inflammatory drugs [NSAIDs],

aspirin), steroids, contraceptives, and vitamins A and D have been associated with subconjunctival
hemorrhage.

 Normal sequelae of ocular surgery even if no conjunctival incision

 Several febrile systemic infections can cause subconjunctival hemorrhage, including meningococcal
septicemia, scarlet fever, typhoid fever, cholera, rickettsia, malaria, and viruses (eg, influenza,
smallpox, measles, yellow fever, sandfly fever).

 Subconjunctival hemorrhage has been reported as a result of emboli from long bone fractures, chest
compression, cardiac angiography, open-heart surgery, and other remote operations.

DIFFERENTIALS Section 4 of 10
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Conjunctivitis, Acute Hemorrhagic

Red Eye Evaluation

Other Problems to be Considered:

Kaposi sarcoma
Other conjunctival neoplasms with secondary hemorrhage

WORKUP Section 5 of 10
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Lab Studies:
  Usually, no laboratory studies are indicated.

o Check blood pressure.

o If history of trauma, rule out ruptured globe or retrobulbar hemorrhage.

o In recurrent cases or if history of bleeding problems (eg, epistaxis, easy bruising), a bleeding time, prothrombin
time/activated partial thromboplastin time (PT/aPTT), CBC with platelets, and protein C and S should be obtained with
consideration for consultation to an internist.

TREATMENT Section 6 of 10
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Medical Care: Medical care is not required.

 Artificial tears can be used 4 times per day for mild irritation.

 Discourage elective use of aspirin products or NSAIDs.

Consultations: Referral to an internist or family physician should be made as indicated for hypertension or bleeding diathesis.

MEDICATION Section 7 of 10
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Medications are not indicated for this condition.

FOLLOW-UP Section 8 of 10
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Further Outpatient Care:

  With time and blood breakdown, hemorrhage may become green or yellow, like a bruise, spreading around the
circumference of the globe. Usually, this disappears within 2 weeks.

 Patients are told to return if blood does not fully resolve or if they have a recurrence.

Prognosis:

 Prognosis is excellent.

Patient Education:

 For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient
education articles Subconjunctival Hemorrhage (Bleeding in Eye) and Black Eye.

MISCELLANEOUS Section 9 of 10
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Special Concerns:

 Occurrence of subconjunctival hemorrhage in an eye after scleral buckle indicates buckle infection until proven
otherwise even if the surgery was performed years before. Usually, there is focal tenderness somewhere over the
buckle.

BIBLIOGRAPHY Section 10 of 10
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 American Academy of Ophthalmology: External disease and cornea. In: Basic and Clinical Science Course. Vol 8.
American Academy of Ophthalmology; 1995:292.
 Fraunfelder FT: Drug Induced Ocular Side Effects and Drug Interactions. 3rd ed. Philadelphia: Lea & Febiger;
1989.
 Friberg TR, Weinreb RN: Ocular manifestations of gravity inversion. JAMA 1985 Mar 22-29; 253(12): 1755-
7[Medline].
  Rhee DJ: Subconjunctival hemorrhage. In: Wills Eye Manual: Office & Emergency Room Diagnosis & Treatment of
Eye Disease . 3rd ed. Lippincott Williams & Wilkins; 1999:130-131.
 Russell SR, Olsen KR, Folk JC: Predictors of scleral rupture and the role of vitrectomy in severe blunt ocular
trauma. Am J Ophthalmol 1988 Mar 15; 105(3): 253-7[Medline].
 Shields SR: Managing eye disease in primary care. Part 2. How to recognize and treat common eye problems.
Postgrad Med 2000 Oct; 108(5): 83-6, 91-6[Medline].
 Spitzer SG, Luorno J, Noel LP: Isolated subconjunctival hemorrhages in nonaccidental trauma. J AAPOS 2005
Feb; 9(1): 53-6[Medline].
 van Heuven WAJ: Subconjunctival hemorrhage. In: Decision Making in Ophthalmology: An Algorithmic Approach.
Mosby-Year Book; 2000:66-67.
 Wirbelauer C: Management of the red eye for the primary care physician. Am J Med 2006 Apr; 119(4): 302-
6[Medline].
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