Subconjunctival Haemorrhage Causes, Symptoms, and Treatment

Authored by , Reviewed by Dr Colin Tidy | Last edited | Meets Patient’s editorial guidelines

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Subconjunctival haemorrhage results from bleeding of the conjunctival or episcleral blood vessels into the subconjunctival space. Causes may be traumatic or non-traumatic. Non-traumatic causes may be idiopathic or associated with other medical conditions.

  • It is a common presentation.
  • The incidence of non-traumatic versus traumatic subconjunctival haemorrhage depends on the characteristics of the population.
  • One Taiwanese study reported a mean annual incidence of non-traumatic subconjunctival haemorrhage to be about 0.6%.[2]
  • It can occur at all ages but is more common with increasing age, probably as a result of increasing frequency of risk factors.[3]
  • There is little robust evidence about gender differences. One study reported that non-traumatic subconjunctival haemorrhage is more common in women than men.[2] Another study reported that traumatic subconjunctival haemorrhage is more common in young men.[4]
  • It is common in the newborn.

The cause of a subconjunctival haemorrhage is usually idiopathic.

Other causes include:

  • Valsalva manoeuvre (eg, coughing, sneezing, vomiting or straining; weight lifting; it has also been reported as a complication of bronchoscopy and endoscopy.[5] )
  • Trauma - surgical or accidental (isolated or associated with retrobulbar haemorrhage or ruptured globe). This can include minor trauma, such as rubbing the eye, which the patient may not recall.
  • Contact lenses.[6]
  • Hypertension.
  • Bleeding disorders.
  • Diabetes mellitus.
  • Hyperlipidaemia.
  • Coronary heart disease.
  • Drugs - eg, warfarin, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), steroids.
  • Normal sequelae of ocular surgery even if there is no conjunctival incision.
  • Febrile systemic infections.

Diseases which can present with subconjunctival haemorrhage include:[7]

  • Stevens-Johnson syndrome.
  • Haemochromatosis.
  • Pyogenic granuloma.
  • Telangiectasias.
  • Haemangiomas.
  • Red eye, usually unilateral.
  • It is usually asymptomatic, but there may be mild irritation of the eye.
  • The patient may not be aware of its presence but it has been reported to them by family or friends, who can find its appearance quite alarming.


  • The most common appearance is a flat, bright red patch anywhere in the conjunctiva with sharply defined edges and relatively normal conjunctiva surrounding it.
  • Overall, subconjunctival haemorrhages are most commonly found in the inferior conjunctiva, but traumatic subconjunctival haemorrhages are more common in the temporal area and tend to be more localised.[8]
  • The haemorrhage may spread and become green or yellow, like a bruise. Usually it 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.

Subconjunctival haemorrhage: "Red eye"

Subconjunctival haemorrhage
Standardissue at en.wikipedia, CC BY-SA 3.0, via Wikimedia Commons

By Standardissue at en.wikipedia, CC BY-SA 3.0, via Wikimedia Commons

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:

  • Check blood pressure.
  • No laboratory studies are indicated if it is an isolated problem.
  • 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.[9]
  • Medical care is not required, unless there is an underlying disorder.
  • Artificial tears can be used four times per day for mild eye irritation.
  • Discourage elective use of aspirin products or NSAIDs.
  • Simultaneous bilateral haemorrhages, and persistent or unexplained recurrence, warrant a referral to the ophthalmologist.
  • Consider non-accidental injury in infants with bilateral isolated subconjunctival haemorrhages, especially if associated with facial petechiae.
  • Subconjunctival haemorrhage is a benign, self-limiting condition when not associated with systemic illness.
  • The prognosis is excellent.
  • There may be a small increased risk of stroke in the three years following a subconjunctival haemorrhage.[10]

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Further reading and references

  1. Tarlan B, Kiratli H; Subconjunctival hemorrhage: risk factors and potential indicators. Clin Ophthalmol. 20137:1163-70. doi: 10.2147/OPTH.S35062. Epub 2013 Jun 12.

  2. Hu DN, Mou CH, Chao SC, et al; Incidence of Non-Traumatic Subconjunctival Hemorrhage in a Nationwide Study in Taiwan from 2000 to 2011. PLoS One. 2015 Jul 1610(7):e0132762. doi: 10.1371/journal.pone.0132762. eCollection 2015.

  3. Mimura T, Usui T, Yamagami S, et al; Recent causes of subconjunctival hemorrhage. Ophthalmologica. 2010224(3):133-7. doi: 10.1159/000236038. Epub 2009 Sep 9.

  4. Sahinoglu-Keskek N, Cevher S, Ergin A; Analysis of subconjunctival hemorrhage. Pak J Med Sci. 2013 Jan29(1):132-4. doi: 10.12669/pjms.291.2802.

  5. Lim HY, Puah SH, Ang LJ, et al; Subconjunctival haemorrhage from bronchoscopy: A case report. Respir Med Case Rep. 2015 Sep 316:97-100. doi: 10.1016/j.rmcr.2015.08.008. eCollection 2015.

  6. Mimura T, Yamagami S, Mori M, et al; Contact lens-induced subconjunctival hemorrhage. Am J Ophthalmol. 2010 Nov150(5):656-665.e1. doi: 10.1016/j.ajo.2010.05.028. Epub 2010 Aug 14.

  7. Doshi R, Noohani T; Subconjunctival Hemorrhage. StatPearls, Jan 2022.

  8. Mimura T, Yamagami S, Usui T, et al; Location and extent of subconjunctival hemorrhage. Ophthalmologica. 2010224(2):90-5. doi: 10.1159/000235798. Epub 2009 Aug 28.

  9. Cronau H, Kankanala RR, Mauger T; Diagnosis and management of red eye in primary care. Am Fam Physician. 2010 Jan 1581(2):137-44.

  10. Wang TJ, Keller JJ, Sheu JJ, et al; A 3-year follow-up study on the risk of stroke among patients with conjunctival haemorrhage. Acta Ophthalmol. 2013 May91(3):226-30. doi: 10.1111/j.1755-3768.2011.02359.x. Epub 2012 Mar 9.