Subconjunctival Bleeding

Subconjunctival bleeding
Other names: Subconjunctival hemorrhage, subconjunctival haemorrhage, hyposphagma
Subconjunctival hemorrhage resulting in red coloration of the white of the eye.
Specialty	Ophthalmology
Symptoms	Red spot over whites of the eye, little to no pain[1]
Complications	None[2]
Duration	Two to three weeks[2]
Types	Traumatic, spontaneous[2]
Causes	Coughing, vomiting, direct injury[2]
Risk factors	High blood pressure, diabetes, older age[2]
Diagnostic method	Based on the appearance[2]
Differential diagnosis	Open globe, retrobulbar hematoma, conjunctivitis, pterygium[2]
Treatment	No specific treatment[3]
Medication	Artificial tears[2]
Prognosis	Good, 10% risk of reoccurance[2]
Frequency	Common[4]

Subconjunctival bleeding, also known as subconjunctival hemorrhage, is bleeding from a small blood vessel over the whites of the eye.^[1] It results in a red spot in the white of the eye.^[1] There is generally little to no pain and vision is not affected.^[2][3] Typically only one eye is affected.^[2]

Causes can include coughing, vomiting, heavy lifting, and direct injury including that from wearing contact lenses.^[2] Risk factors include high blood pressure, diabetes, older age, blood thinners, and trauma including that from wearing contact lenses.^[2] They occur in about 2% of newborns following a vaginal delivery.^[2] The blood occurs between the conjunctiva and the episclera.^[2] Diagnosis is largely based on the appearance.^[2]

Usually no specific treatment is required and the condition improves in two to three weeks.^[2] Artificial tears may be used to help with any irritation.^[2] They occur relatively commonly.^[4] Both sexes are affected equally.^[2] Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males.^[2]

Signs and symptoms[edit | edit source]

Subconjunctival bleeding is bleeding from a small blood vessel over the whites of the eye.^[1] It results in one or more red spots in the white of the eye, usually noticed when looking in the mirror.^[1] There is generally little to no pain and vision is not affected.^[2][3] Typically only one eye is affected.^[2]

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 2 weeks.^[5]

• 

  Minor subconjunctival bleed

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  After one week

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  Same as prior after four weeks

• 

  As viewed through a slit lamp

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  After 48 hours

Causes[edit | edit source]

Subconjunctival bleeding can occur without a trigger, or due to trauma, infection or bleeding disorder.^[6] Mostly it occurs spontaneously, particularly in older people with more fragile blood vessels.^[6]

It can be caused by head injury and trauma to the eye, or after eye surgery such as LASIK.^[6][7] Other traumatic causes may arise from straining such as heavy lifting or vomiting, or from increased pressure in the chest and abdomen such as from being squeezed in a crowd.^[6] Choking, or coughing may cause subconjunctival bleeding.^[2] Another cause may be constipation.^[2] Zygoma fracture results in lateral subconjunctival bleeding.^{[citation needed]} Another cause is mask squeeze from diving and not equalizing mask pressure during descent.^[8] Causes include atmospheric pressure changes such as those from diving deeply in water and aircraft altitude changes.^[9]

Infections such as conjunctivitis can result in a subconjunctival bleed.^[6] Other infections included Ebola, acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus), Leptospirosis.^{[citation needed]}

Rarely there may be a serious cause such as a bleeding disorder or leukaemia, conditions in which the subconjunctival bleeding may be recurrent.^[6]

Subconjunctival bleeding in children may be associated with scurvy (vitamin C deficiency), whooping cough, malaria, purpura,^[6][10] abuse or traumatic asphyxia syndrome.^[11]

Risk factors[edit | edit source]

Risk factors include high blood pressure, diabetes, older age, blood thinners, and wearing contact lenses.^[2]

Diagnosis[edit | edit source]

Diagnosis is based on the appearance, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye.^[2]

Management[edit | edit source]

Subconjunctival bleeding is typically a self-limiting condition that requires no specific treatment unless there is evidence of an infection or there has been significant injury. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy.^[5][6] The elective use of aspirin is typically discouraged.^[6]

References[edit | edit source]

External links[edit | edit source]

Classification	ICD-10: H11.3 ICD-9-CM: 372.72
External resources	MedlinePlus: 001616