PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.
Subconjunctival haemorrhage results from bleeding of the conjunctival or the episcleral blood vessels into the subconjunctival space. The cause is usually unknown but may be the result of trauma or related to systemic illness.
- Occurs frequently.
- Subconjunctival haemorrhage can occur at all ages but is more common with increasing age.
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The cause is usually unknown.
- Valsalva manoeuvre (eg, coughing, straining).
- Trauma - surgical or accidental (isolated or associated with retrobulbar haemorrhage or ruptured globe).
- Contact lenses.
- Bleeding disorders.
- Various drugs - eg, warfarin, non-steroidal anti-inflammatory drugs (NSAIDs), steroids.
- Normal sequelae of ocular surgery even if there is no conjunctival incision.
- Febrile systemic infections.
- There is an increased incidence in people with diabetes, hyperlipidaemia and ischaemic heart disease.
- Red eye, usually unilateral
- May have mild irritation
- Usually asymptomatic
- The most common appearance is a bright red patch with relatively normal surrounding.
- The haemorrhage may spread and become green or yellow, like a bruise. Usually this disappears within two weeks.
- Examination of the eye, including pupil responses and visual acuity, is otherwise normal.
It is worth noting that a haemorrhage without a posterior margin (ie extends posteriorly so that the whole extent of the haemorrhage cannot be seen) may be associated with an intracranial bleed or an orbital roof fracture (associated with a black eye) - the history should guide you as to whether to consider this or not.
Other causes of acute red eye, including:
If it is a persistent haemorrhage (as opposed to the conjunctival injection seen in a red eye), consider rarer causes such as:
- Kaposi's sarcoma
- Other conjunctival neoplasms
- Usually, no laboratory studies are indicated.
- Check blood pressure.
- If there is history of trauma, the patient may need referral to rule out more extensive eye injury.
- In recurrent cases, investigation for an underlying bleeding disorder may be indicated.
- Medical care is not required, unless there is an underlying disorder.
- Artificial tears can be used four times per day for mild irritation.
- Discourage elective use of aspirin products or NSAIDs.
- Simultaneous bilateral haemorrhages, and persistent or unexplained recurrence warrant a referral to the ophthalmologists.
- Subconjunctival haemorrhage is a benign, self-limiting condition when not associated to systemic illness.
- Prognosis is excellent.
Further reading & references
- Mimura T, Usui T, Yamagami S, et al; Recent causes of subconjunctival hemorrhage. Ophthalmologica. 2010;224(3):133-7. doi: 10.1159/000236038. Epub 2009 Sep 9.
- Tarlan B, Kiratli H; Subconjunctival hemorrhage: risk factors and potential indicators. Clin Ophthalmol. 2013;7:1163-70. doi: 10.2147/OPTH.S35062. Epub 2013 Jun 12.
- Mimura T, Yamagami S, Mori M, et al; Contact lens-induced subconjunctival hemorrhage. Am J Ophthalmol. 2010 Nov;150(5):656-665.e1. doi: 10.1016/j.ajo.2010.05.028. Epub 2010 Aug 14.
- Mimura T, Yamagami S, Usui T, et al; Location and extent of subconjunctival hemorrhage. Ophthalmologica. 2010;224(2):90-5. doi: 10.1159/000235798. Epub 2009 Aug 28.
- Cronau H, Kankanala RR, Mauger T; Diagnosis and management of red eye in primary care. Am Fam Physician. 2010 Jan 15;81(2):137-44.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Colin Tidy
Dr Colin Tidy
Dr Helen Huins