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Subconjunctival bleeding
Other names	Subconjunctival hemorrhage, subconjunctival haemorrhage, hyposphagma
Subconjunctival hemorrhage resulting in red coloration of the white of the eye.
Specialty	Ophthalmology, Optometry
Symptoms	Red spot over whites of the eye, little to no pain
Complications	None
Duration	One to two weeks
Types	Traumatic, spontaneous
Causes	Coughing, vomiting, direct injury
Risk factors	High blood pressure, diabetes, older age
Diagnostic method	Based on the appearance
Differential diagnosis	Open globe, retrobulbar hematoma, conjunctivitis, pterygium
Treatment	No specific treatment
Medication	Artificial tears
Prognosis	Good, 10% risk of reoccurance
Frequency	Common

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.

Natural causes can include coughing, vomiting, heavy lifting, straining to pass hard stools during acute constipation or the act of "pushing" or "bearing down" during labour/childbirth 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. External causes can include direct impact/injury from an accidental bump or a physical altercation resulting in blunt force trauma. Risk factors include hypertension, diabetes, old age, and blood thinners. They occur in about 2% of newborns following a vaginal delivery. The blood occurs between the conjunctiva and the episclera. Diagnosis is generally based on the appearance.

Generally no specific treatment is required and the condition improves in two to three weeks. Artificial tears may be used to help with any irritation. They occur relatively commonly. 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.

Signs and symptoms

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.

Causes

• Mechanical
  • Increased venous pressure (e.g. extreme g-force, straining, vomiting, choking, coughing or strangling) or from straining due to constipation
  • External pressure changes:
    • Atmospheric pressure changes due to aircraft altitude changes.
    • Mask squeeze from diving without equalizing mask pressure during descent or from diving deeply in water
  • Eye injury
  • Head injury
  • Laser eye surgery or other eye surgery
  • Zygoma fracture (results in lateral subconjunctival bleeding)
• Medical conditions that cause increased venous pressure:
  • Whooping cough or other extreme sneezing or coughing
  • Severe hypertension
• Medical conditions that affect blood or blood vessels:
  • Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
  • Coagulation disorder (congenital or acquired) including Ebola
  • Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
  • Leptospirosis

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. J.P. Campbell (February 2017). "Detailed Vascular Anatomy of the Human Retina by Projection-Resolved Optical Coherence Tomography Angiography". Scientific Reports. Retrieved 11 November 2021.
6. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.
7. ^ "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.
8. ^ "Subconjunctival hemorrhage". Disease.com. n.d. Archived from the original on May 13, 2012. Retrieved October 15, 2012.
9. Bruce M. Rothschild (December 17, 2008). "Scurvy". eMedicine.com. Retrieved Mar 26, 2022.
10. 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.
11. Robert H. Grahamn (February 2009). "Subconjunctival Hemorrhage". emedicine.com. Retrieved 23 November 2010.

External links

• Disorders of conjunctiva