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{{Short description|Bleeding within the whites of the eye}}
{{Infobox medical condition (new) {{Infobox medical condition (new)
| name = Subconjunctival bleeding | name = Subconjunctival bleeding
| synonyms = Subconjunctival hemorrhage, subconjunctival haemorrhage, hyposphagma | synonyms = Subconjunctival hemorrhage, hyposphagma
| image = Human eye showing subconjunctival hemorrhage.jpg | image = SubconjunctivalHaemorrhage.jpeg
| caption = Subconjunctival hemorrhage resulting in red coloration of the white of the eye. | caption = Subconjunctival hemorrhage resulting in red coloration of the white of the eye
| pronounce = | pronounce =
| field = ], ] | field = ], ]
| symptoms = Red spot over whites of the eye, little to no pain<ref name=AAO2019/> | symptoms = Red spot over whites of the eye, little to no pain
| complications = None<ref name=Stat2020/> | complications = None
| onset = | onset =
| duration = Two to three weeks<ref name=Stat2020/> | duration = One to two weeks
| types = Traumatic, spontaneous<ref name=Stat2020/> | types = Traumatic, spontaneous
| causes = Coughing, vomiting, direct injury<ref name=Stat2020/> | causes = Coughing, vomiting, direct injury
| risks = ], ], older age<ref name=Stat2020/> | risks = ], ], older age
| diagnosis = Based on the appearance<ref name=Stat2020/> | diagnosis = Based on appearance
| differential = ], ], ], ]<ref name=Stat2020/> | differential = ], ], ], ]
| prevention = | prevention =
| treatment = No specific treatment<ref name=AFP2010/> | treatment = No specific treatment
| medication = ]<ref name=Stat2020/> | medication = ]
| prognosis = Good, 10% risk of reoccurance<ref name=Stat2020/> | prognosis = Good, 10% risk of recurrence
| frequency = Common<ref name=Gold2010/> | frequency = Common
| deaths = | deaths =
}} }}
<!-- Definition and symptoms --> <!-- Definition and symptoms -->
'''Subconjunctival bleeding''', also known as '''subconjunctival hemorrhage''' or '''subconjunctival haemorrhage''', is bleeding from a small ] over the ].<ref name=AAO2019>{{cite web |title=What is a Subconjunctival Hemorrhage? |url=https://www.aao.org/eye-health/diseases/what-is-subconjunctival-hemorrhage |website=American Academy of Ophthalmology |access-date=17 October 2019 |language=en |date=3 July 2019}}</ref> It results in a red spot in the white of the eye.<ref name=AAO2019/> There is generally little to no pain and vision is not affected.<ref name=Stat2020>{{cite book |last1=Doshi |first1=R |last2=Noohani |first2=T |title=Subconjunctival Hemorrhage |date=January 2020 |pmid=31869130}}</ref><ref name=AFP2010>{{cite journal |last1=Cronau |first1=H |last2=Kankanala |first2=RR |last3=Mauger |first3=T |title=Diagnosis and management of red eye in primary care. |journal=American Family Physician |date=15 January 2010 |volume=81 |issue=2 |pages=137–44 |pmid=20082509}}</ref> Generally only one eye is affected.<ref name=Stat2020/> '''Subconjunctival bleeding''', also known as '''subconjunctival hemorrhage''' or '''subconjunctival haemorrhage''', is bleeding from a small ] over the ]. It results in a red spot in the white of the eye.<ref name=AAO2019>{{cite web |title=What is a Subconjunctival Hemorrhage? |url=https://www.aao.org/eye-health/diseases/what-is-subconjunctival-hemorrhage |website=American Academy of Ophthalmology |access-date=17 October 2019 |date=3 July 2019}}</ref> There is generally little to no pain and vision is not affected.<ref name=Stat2020>{{cite book |last1=Doshi |first1=R |last2=Noohani |first2=T |title=Subconjunctival Hemorrhage |date=January 2020 |pmid=31869130}}</ref><ref name=AFP2010>{{cite journal |last1=Cronau |first1=H |last2=Kankanala |first2=RR |last3=Mauger |first3=T |title=Diagnosis and management of red eye in primary care. |journal=American Family Physician |date=15 January 2010 |volume=81 |issue=2 |pages=137–44 |pmid=20082509}}</ref> Generally only one eye is affected.<ref name=Stat2020/>


<!-- Cause and diagnosis --> <!-- Cause and diagnosis -->
Natural causes can include coughing, vomiting, heavy lifting, straining to pass hard stools during acute ] or the act of "pushing" or "bearing down" during labour/] as these activities can increase the blood pressure in the vascular systems supplying the retina. There are up to four vascular retinal plexuses that are supplied by tiny, delicate capillaries whose walls if encountered with a sudden amount of force from blood will rupture.<ref>{{cite web |url=https://www.nature.com/articles/srep42201 |title=Detailed Vascular Anatomy of the Human Retina by Projection-Resolved Optical Coherence Tomography Angiography |author=J.P. Campbell |date=February 2017 |publisher=Scientific Reports |access-date=11 November 2021}}</ref> External causes can include direct impact/injury from an accidental bump or a physical altercation resulting in blunt force trauma. Risk factors include hypertension, ], old age, and ]s. They occur in about 2% of newborns following a ].<ref name=Stat2020/> The blood occurs between the ] and the ].<ref name=Stat2020/> Diagnosis is generally based on the appearance.<ref name=Stat2020/> Causes can include coughing, vomiting, heavy lifting, straining during acute ] or the act of "bearing down" during childbirth, as these activities can increase the blood pressure in the vascular systems supplying the conjunctiva. Other causes include blunt or penetrating trauma to the eye. Risk factors include hypertension, diabetes, old age, and ]s. Subconjunctival bleeding occurs in about 2% of newborns following a ]. The blood accumulates between the ] and the ]. Diagnosis is generally based on the appearance of the conjunctiva.<ref name=Stat2020/>


<!-- Treatment, prognosis, and epidemiology --> <!-- Epidemiology, prognosis and treatment -->
Generally no specific treatment is required and the condition improves in two to three weeks.<ref name=Stat2020/> ] may be used to help with any irritation.<ref name=Stat2020/> They occur relatively commonly.<ref name=Gold2010>{{cite book |last1=Gold |first1=Daniel H. |last2=Lewis |first2=Richard Alan |title=Clinical Eye Atlas |date=2010 |publisher=Oxford University Press |isbn=978-0-19-534217-8 |page=82 |url=https://www.google.com/books/edition/Clinical_Eye_Atlas/qDd_IiblCiUC?hl=en&gbpv=1&dq=Subconjunctival+hemorrhage+prevalence&pg=PA82 |language=en}}</ref> Both sexes are affected equally.<ref name=Stat2020/> Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males.<ref name=Stat2020/> The condition is relatively common,<ref name=Gold2010>{{cite book |last1=Gold |first1=Daniel H. |last2=Lewis |first2=Richard Alan |title=Clinical Eye Atlas |date=2010 |publisher=Oxford University Press |isbn=978-0-19-534217-8 |page=82 |url=https://books.google.com/books?id=qDd_IiblCiUC&dq=Subconjunctival+hemorrhage+prevalence&pg=PA82}}</ref> and both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males. Generally no specific treatment is required and the condition resolves over two to three weeks. ] may be used to alleviate irritation.<ref name=Stat2020/>


==Signs and symptoms== ==Signs and symptoms==
⚫ Subconjunctival bleeding initially appears bright red underneath the transparent bulbar conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within two weeks.<ref>{{cite web |url=http://www.emedicine.com/oph/topic270.htm |title=Subconjunctival Hemorrhage |author=Robert H. Grahamn |date=February 2009 |work=emedicine.com |access-date=23 November 2010}}</ref> The affected eye may feel dry, rough, or scratchy, but the condition is not usually painful.

A subconjunctival bleeding usually does not result in pain, although occasionally the affected eye may feel dry, rough, or scratchy.

⚫ A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within two weeks.<ref>{{cite web |url=http://www.emedicine.com/oph/topic270.htm |title=Subconjunctival Hemorrhage |author=Robert H. Grahamn |date=February 2009 |work=emedicine.com |access-date=23 November 2010}}</ref>


==Causes== ==Causes==
* Mechanical *Mechanical
** Increased venous pressure (e.g. extreme ], straining, ], ], ] or ])<ref name=NIH /><ref name=Disease /> or from straining due to ] **Increased venous pressure (e.g. extreme ], straining, vomiting, choking, sneezing, coughing or ])<ref name=NIH /><ref name=Disease /> or from straining due to ]
** External pressure changes:<ref name=NIH> **External pressure changes:<ref name=NIH>
{{cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002583/ | url-status = dead {{cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002583/ | url-status = dead
| archive-url = https://web.archive.org/web/20140202172547/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002583/ | archive-date = Feb 2, 2014 | archive-url = https://web.archive.org/web/20140202172547/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002583/ | archive-date = Feb 2, 2014
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|work=Disease.com |title=Subconjunctival hemorrhage |date=n.d. |work=Disease.com |title=Subconjunctival hemorrhage |date=n.d.
}}</ref> }}</ref>
*** Atmospheric pressure changes due to aircraft altitude changes. ***Atmospheric pressure changes due to aircraft altitude changes
*** ] from diving without equalizing mask pressure during descent or from diving deeply in water ***] from scuba diving without equalizing mask pressure during descent
** ] **] or eye surgery
⚫ **] (results in ] subconjunctival bleeding)
** ]
⚫ *Medical conditions that affect blood or blood vessels:
** ] or other eye surgery
⚫ **Severe ]
⚫ ** ] (results in ] subconjunctival bleeding)
**]
* Medical conditions that cause increased venous pressure:
⚫ **] (congenital or acquired)
** ] or other extreme sneezing or coughing<ref name=NIH />
⚫ **] (caused by including enterovirus 70, coxsackievirus A24 variant, and adenovirus 11)
⚫ ** Severe ]
⚫ **]
⚫ * Medical conditions that affect blood or blood vessels:
** Certain infections of the outside of the eye (]) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
⚫ ** ] (congenital or acquired) including ]
⚫ ** Acute hemorrhagic conjunctivitis (caused by ] 70 or ])
⚫ ** ]


Subconjunctival bleeding in infants may be associated with ] (a vitamin C deficiency),<!-- <ref> Subconjunctival bleeding in infants may be associated with ] (a vitamin C deficiency),<!-- <ref>
Line 74: Line 68:


==Diagnosis== ==Diagnosis==
Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. In rare cases blood may drip from the eye.


==Management== ==Management==

A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. ] may be applied four to six times a day if the eye feels dry or scratchy.<ref>{{cite web |url=http://www.emedicine.com/oph/topic270.htm |title=Subconjunctival Hemorrhage |author=Robert H. Grahamn |date=February 2009 |publisher=emedicine.com |access-date=23 November 2010}}</ref> The elective use of ] is typically discouraged. A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. ] may be applied four to six times a day if the eye feels dry or scratchy.<ref>{{cite web |url=http://www.emedicine.com/oph/topic270.htm |title=Subconjunctival Hemorrhage |author=Robert H. Grahamn |date=February 2009 |publisher=emedicine.com |access-date=23 November 2010}}</ref> The elective use of ] is typically discouraged.


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{{Reflist}} {{Reflist}}


== External links == ==External links ==
{{Medical resources {{Medical resources
| ICD10 = {{ICD10|H|11|3|h|10}} | ICD10 = {{ICD10|H|11|3|h|10}}
| ICD9 = {{ICD9|372.72}} | ICD9 = {{ICD9|372.72}}
| ICDO = | ICDO =
| OMIM = | OMIM =
| OMIM_mult = | OMIM_mult =
| MedlinePlus = 001616 | MedlinePlus = 001616
| eMedicineSubj = | eMedicineSubj =
| eMedicineTopic = | eMedicineTopic =
| eMedicine_mult = {{eMedicine2|oph|270}} | eMedicine_mult = {{eMedicine2|oph|270}}

Latest revision as of 16:41, 31 July 2024

Bleeding within the whites of the eye Medical condition
Subconjunctival bleeding
Other namesSubconjunctival hemorrhage, hyposphagma
Subconjunctival hemorrhage resulting in red coloration of the white of the eye
SpecialtyOphthalmology, Optometry
SymptomsRed spot over whites of the eye, little to no pain
ComplicationsNone
DurationOne to two weeks
TypesTraumatic, spontaneous
CausesCoughing, vomiting, direct injury
Risk factorsHigh blood pressure, diabetes, older age
Diagnostic methodBased on appearance
Differential diagnosisOpen globe, retrobulbar hematoma, conjunctivitis, pterygium
TreatmentNo specific treatment
MedicationArtificial tears
PrognosisGood, 10% risk of recurrence
FrequencyCommon

Subconjunctival bleeding, also known as subconjunctival hemorrhage or subconjunctival haemorrhage, is bleeding from a small blood vessel over the whites of the eye. It results in a red spot in the white of the eye. There is generally little to no pain and vision is not affected. Generally only one eye is affected.

Causes can include coughing, vomiting, heavy lifting, straining during acute constipation or the act of "bearing down" during childbirth, as these activities can increase the blood pressure in the vascular systems supplying the conjunctiva. Other causes include blunt or penetrating trauma to the eye. Risk factors include hypertension, diabetes, old age, and blood thinners. Subconjunctival bleeding occurs in about 2% of newborns following a vaginal delivery. The blood accumulates between the conjunctiva and the episclera. Diagnosis is generally based on the appearance of the conjunctiva.

The condition is relatively common, and both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males. Generally no specific treatment is required and the condition resolves over two to three weeks. Artificial tears may be used to alleviate irritation.

Signs and symptoms

Subconjunctival bleeding initially appears bright red underneath the transparent bulbar conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within two weeks. The affected eye may feel dry, rough, or scratchy, but the condition is not usually painful.

Causes

Subconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency), abuse or traumatic asphyxia syndrome.

Diagnosis

Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. In rare cases blood may drip from the eye.

Management

A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged.

References

  1. "What is a Subconjunctival Hemorrhage?". American Academy of Ophthalmology. 3 July 2019. Retrieved 17 October 2019.
  2. ^ Doshi, R; Noohani, T (January 2020). Subconjunctival Hemorrhage. PMID 31869130.
  3. Cronau, H; Kankanala, RR; Mauger, T (15 January 2010). "Diagnosis and management of red eye in primary care". American Family Physician. 81 (2): 137–44. PMID 20082509.
  4. Gold, Daniel H.; Lewis, Richard Alan (2010). Clinical Eye Atlas. Oxford University Press. p. 82. ISBN 978-0-19-534217-8.
  5. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.
  6. ^ "Subconjunctival hemorrhage". PubMed Health on the National Institutes of Health website. May 1, 2011. Archived from the original on Feb 2, 2014. Retrieved October 15, 2012.
  7. ^ "Subconjunctival hemorrhage". Disease.com. n.d. Archived from the original on May 13, 2012. Retrieved October 15, 2012.
  8. Bruce M. Rothschild (December 17, 2008). "Scurvy". eMedicine.com. Retrieved Mar 26, 2022.
  9. Spitzer S. G; Luorno J.; Noël L. P. (2005). "Isolated subconjunctival hemorrhages in nonaccidental trauma". Journal of American Association for Pediatric Ophthalmology and Strabismus. 9 (1): 53–56. doi:10.1016/j.jaapos.2004.10.003. PMID 15729281.
  10. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.

External links

ClassificationD
External resources
Adnexa
Eyelid
Inflammation
Eyelash
Lacrimal apparatus
Orbit
Conjunctiva
Globe
Fibrous tunic
Sclera
Cornea
Vascular tunic
Choroid
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Retina
Other
Pathways
Optic nerve
Optic disc
Optic neuropathy
Strabismus
Extraocular muscles
Binocular vision
Accommodation
Paralytic strabismus
palsies
Other strabismus
Other binocular
Refraction
Vision disorders
Blindness
Anopsia
subjective
Pupil
Other
Infections
Disorders of bleeding and clotting
Clotting
By cause
Clots
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Bleeding
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Thrombocytopenia
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