Subconjunctival Hemorrhage (Bleeding in Eye)

Subconjunctival Hemorrhage Overview

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.

Subconjunctival Hemorrhage Causes

Most subconjunctival hemorrhages are spontaneous without an obvious cause for this bleeding from the conjunctival vessels. Often, a person may discover a subconjunctival hemorrhage on awakening and looking in the mirror. Most spontaneous subconjunctival hemorrhages are first noticed by another person seeing a red spot on your eye.

The following can occasionally result in a spontaneous subconjunctival hemorrhage:

• sneezing,
  
  
• coughing,
  
  
• straining/vomiting,
  
  
• eye rubbing,
  
  
• trauma (injury),
  
  
• high blood pressure,
  
  
• bleeding disorder, or
  
  
• a medical disorder causing bleeding or inhibiting normal clotting.

Subconjunctival hemorrhage can also be non-spontaneous and result from a severe eye infection, trauma to the head or eye, or after eye or eyelid surgery.

Subconjunctival Hemorrhage Symptoms

Most of the time, no symptoms are associated with a subconjunctival hemorrhage other than seeing blood over the white part of the eye.

• Very rarely do people experience any pain when the hemorrhage begins. When the bleeding first occurs, you may experience a sense of fullness in the eye or under the lid. As the hemorrhage resolves, some people may experience very mild irritation of the eye or merely a sense of awareness of the eye.
  
  
• The hemorrhage itself is an obvious, sharply outlined bright red area overlying the sclera. The entire white part of the eye may occasionally be covered by blood.
  
  
• In a spontaneous subconjunctival hemorrhage, no blood will exit from the eye. If you blot the eye with a tissue, there should be no blood on the tissue.
  
  
• The hemorrhage will appear larger within the first 24 hours after its onset and then will slowly decrease in size as the blood is absorbed.

When to Seek Medical Care

Call your ophthalmologist (a medical doctor who specializes in eye care and surgery) if the subconjunctival hemorrhage does not get better within two weeks or if you have had multiple subconjunctival hemorrhages.

Also, call your ophthalmologist if you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with other symptoms of bleeding including easy bruising, bleeding gums, or both.

Go to your ophthalmologist immediately if you have a subconjunctival hemorrhage and you have

• pain associated with the hemorrhage,
  
  
• changes in vision (for example, blurry vision, double vision, difficulty seeing),
  
  
• history of a bleeding disorder,
  
  
• history of high blood pressure, or
  
  
• injury from trauma to the eye.