Ophthalmology - Subconjunctival Hemorrhage

A subconjunctival hemorrhage literally means bleeding under the conjunctiva. The conjunctiva is a membrane which covers the front of your eyes and the back of the eyelids. It provides protection to the sensitive structure that is the eye.

To understand this easily, think of the conjunctiva as the skin covering an important organ providing a much needed cover. As you can see in the picture below, the conjunctiva begins on one eylid, then folds to cover the eye, then folds again on the other eyelid. This is the place where tears are secreted.

In a subconjunctival hemorrhage, the bleeding will occur under this membrane.

Most of the time, this appears spontaneously, without a specific cause. The red spots in the eye may be noticed after waking up in the morning, or may be pointed out by someone you're talking to. It can appear after rubbing the eyes or after straining (sneezing, coughing, difficult physical exercise etc.)

Other causes include:

• high blood pressure
• injury to the eye
• bleeding disorder (deficit in blood clotting substances or low platelet counts)

If you only have a small red spot on your eye, it will usually heal by itself without any treatment. Think of it as a bruise. In 1-2 weeks it should be gone. Try not to injure the affected eye any further, avoid straining.

You should see a doctor (ophthalmologist) when:

• the hemorrhage is severe (not only a spot, the whole eye being red)
• the hemorrhage affects both eyes at the same time
• you have had repeated hemorrhages recently
• the bleeding is accompanied by pain
• your vision is affected (blurry / deformed vision, inability to read the way you used to etc.)
• you have a history of high blood pressure
• you have a history of bleeding disorders
• you suffered a severe injury to the eye

This is usually a mild disorder which will go away on its own. You can apply artificial tears to the affected eye to prevent further irritation.

If you have to go to the ophthalmologist, he/she will examine your eye for signs of underlying disorders. He/she may have to apply drops with fluorescent dye to search for trauma/irritation, or to dilate your pupil to examine the retina. Your eyelids will be examined as well because when they become swollen they can cause injury to the conjunctiva.

The treatment prescribed will usually be artificial tears plus any treatment for underlying medical conditions (high blood pressure etc.)

If small subconjunctival hemorrhages happen often, it is a good idea to get a medical checkup, just to rule out other diseases. You may also need to examine the environment in which you live/work and eliminate possible sources of eye problems.