What is a subconjunctival hemorrhage?

A subconjunctival hemorrhage is when a blood vessel breaks in the white of the eye. Then blood builds up below the conjunctiva. It causes a flat, bright red patch in the white of the eye. It's similar to a bruise on the skin.

The conjunctiva is the thin layer that covers the inside of the eyelids and the surface of the eye. It contains many tiny blood vessels that bring oxygen and nutrients to the eye. The sclera is the white part of the eye that is under the conjunctiva. Sometimes a blood vessel in the conjunctiva breaks and bleeds. The blood then collects under the conjunctiva and turns part of the eye red. Over a few weeks, your eye then absorbs the blood.

A subconjunctival hemorrhage can look quite alarming, but it's common and often harmless. They can happen to people of any age. Older adults have them more often.

What causes a subconjunctival hemorrhage?

In many cases, the cause is not known. But some health conditions may increase the risk. These include:

• Eye injury (including injury from eye surgery)

• High blood pressure

• Inflammation of the conjunctiva

• Contact lens use

• Diabetes

• Hardening of the arteries

• Tumor of the conjunctiva

• Diseases that impair blood clotting

• Violent sneezing, coughing, or vomiting

• Certain medicines that can increase bleeding, like aspirin

• Pushing hard during a baby's delivery

• Straining because of constipation

Some of these causes, such as eye injury and contact lens use, are more common in young adults. Others, such as high blood pressure and diabetes, are more common in older adults.

What are the symptoms of a subconjunctival hemorrhage?

Other than a red eye, you likely won’t have any symptoms. You might feel like you have something in your eye. But this is not common. The hemorrhage shouldn’t affect your vision. And it shouldn’t cause any pain. If you do have pain, you may have another problem with your eye.

Some people notice a red eye after an eye injury. Other people might notice their hemorrhage without any injury. They may notice it after waking up in the morning.

In most cases, just one eye will have a hemorrhage. It typically happens once and then goes away. But some health conditions might cause repeated hemorrhages.

How is a subconjunctival hemorrhage diagnosed?

Your healthcare provider will ask about your health history. You may have a physical exam. This includes a basic eye exam. A primary healthcare provider will often make the diagnosis. They will rule out other causes of red eye that might need other treatment.

Your primary care provider might send you to an eye care provider if they think you may have a different problem with your eye. You will need to see an ophthalmologist (doctor who specializes in eye problems) if you have had a serious eye injury. Your provider might use a special lighted microscope to look at your eye in more detail. This helps to show if the injury hurt the eye itself or just its outer layer.

If this is your first subconjunctival hemorrhage, your healthcare provider may not give you more tests. If you have had more than 1, your healthcare provider may need to find the cause. For example, you may need blood tests to check for a blood clotting disorder.

How is a subconjunctival hemorrhage treated?

Most people will not need any treatment. This condition often goes away on its own. Your subconjunctival hemorrhage will likely go away in a few weeks. It will first turn from red to brown, and then to yellow. Currently, there are no treatments that will speed up this process.

Your healthcare provider will mainly focus on treating any underlying disorders that might have caused your subconjunctival hemorrhage. For example, you may need a blood pressure medicine if high blood pressure may have helped to cause it.

Can a subconjunctival hemorrhage be prevented?

In most cases, a subconjunctival hemorrhage is not preventable. Seeking regular treatment for your other health conditions may help prevent some cases of a subconjunctival hemorrhage.

When should I call my healthcare provider?

Call your healthcare provider if your subconjunctival hemorrhage does not go away in 2 to 3 weeks. Also call your healthcare provider right away if you have pain in the eye or vision loss.

If you have a history of eye injury or repeated hemorrhages, get your eye evaluated. An eye care provider needs to examine your eye and rule out more dangerous causes. You may also need to see your regular healthcare provider to rule out other problems, such as high blood pressure or a bleeding disorder.

Key points about subconjunctival hemorrhage

• A subconjunctival hemorrhage is when a blood vessel breaks in the white of the eye. It causes a bright red patch in the white of the eye.

• It may look alarming. But it is generally harmless.

• In many cases, the cause is not known. But some health conditions may increase the risk.

• Your healthcare provider may need to rule out other more serious causes of your red eye. You might need to see an (ophthalmologist).

• Most people will not need any treatment. This condition often goes away on its own in a few weeks.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.