Subconjunctival Haemorrhage
Subconjunctival haemorrhage is a common, usually benign cause of red eye caused by bleeding under the conjunctiva.
This updated UKMLA guide to subconjunctival haemorrhage covers causes, risk factors, symptoms, diagnosis and management.
Causes and Risk Factors
Traumatic causes (more common in younger individuals): [Ref]
- Direct ocular trauma
- Foreign body injury
- Excessive eye rubbing
- Improper contact lens use
Spontaneous causes (more common in older individuals): [Ref]
- Hypertension – most consistently documented risk factor
- Transient elevation in venous pressure (e.g. coughing, vomiting, strenuous exertion, straining in constipation)
- Antiplatelet use / anticoagulant use / clotting disorder
Clinical Features
Painless, red eye
- Typically unilateral
- Normal vision and no photophobia
- A sharply demarcated, bright red patch under the ocular surface
Uncomplicated subconjunctival haemorrhage should not cause discharge, chemosis, proptosis, or ophthalmoplegia.
Assessment and Management
See the Red Eye Referral article for indications to refer to ophthalmology.
Assessment:
- Clinical diagnosis
- Measure the patient’s blood pressure (if raised, see the Hypertension (Primary) article)
- If the patient is on warfarin → check INR (if raised, see the Warfarin article)
Management is conservative:
- Reassure that the haemorrhage will clear spontaneously in 1–2 weeks in most cases
- If symptomatic, a cold compress may help
Topical steroids or antibiotics are NOT recommended in uncomplicated subconjunctival haemorrhage, as they are unnecessary and potentially harmful. [Ref]