Blood in the Eye - An Overview

Introduction

The eyes are a fascinating organ that is the most complex organ next to the brain. It is believed that most of the learning process happens through the eyes. When eyes play a vital role in a human being's life, any injury or damage to the eyes can affect the quality of life. The eyes are made up of layers like cornea, pupil, lens, retina, iris, choroid, and sclera. Damage to any one of these is a problem.

The bloody eye is seen in conditions like subconjunctival hemorrhage and hyphema. A subconjunctival hemorrhage is caused due to a break in the blood vessel. It could happen at any time due to factors that are primarily daily activities. A subconjunctival hemorrhage is considered harmless. Hyphema is a condition in which the blood gets accumulated in the anterior chamber of the eye (the space between the cornea and iris). Trauma is the common factor causing hyphema.

Hyphema and subconjunctival hemorrhage might look similar, but it differs in the location of blood present. In the case of hyphema, the central part of the eye contains the blood, whereas subconjunctival hemorrhage is seen only in the white part of the eye. The causes, symptoms, and management of subconjunctival hemorrhage and hyphema will be discussed in this article.

Subconjunctival Hemorrhage

What Are the Causes of Subconjunctival Hemorrhage?

A person gets affected by subconjunctival hemorrhage due to any of the following.

• Strained cough, sneeze, and vomit.

• Rubbing the eye roughly.

• Contact lens.

• Viral infection.

• As a post-surgery complication.

Less commonly, people get affected by subconjunctival hemorrhage for the following reasons.

• Diabetes.

• Hypertension (increased blood pressure).

• Clotting disorders.

• Taking medications that can cause profuse bleeding like aspirin and warfarin.

What Are the Symptoms of Subconjunctival Hemorrhage?

In most cases, the affected person will not know about the hemorrhage unless noticed in a mirror or another person. It does not show any symptoms like pain or blurred vision. The only sign would be scratchy eyes.

What Are the Risk Factors of Subconjunctival Hemorrhage?

The possible risk factors that would cause subconjunctival hemorrhage includes,

• Diabetes.

• Hypertensive patients.

• Blood-thinning medications like Aspirin and Warfarin.

• Blood clotting disorders.

How to Diagnose Subconjunctival Hemorrhage?

A doctor will diagnose subconjunctival hemorrhage in most cases by just looking at it. Other tests are not needed. But in case the subconjunctival hemorrhage is recurring, then general health has to be examined, including sugar and blood pressure levels. Bleeding and clotting disorders should be discussed too.

How to Manage Subconjunctival Hemorrhage?

Subconjunctival hemorrhage's blood spot will resolve in a few days and does not need medical intervention. Patients may use eye drops to ease the scratchy sensation. If the causative factor is diabetes, hypertension, or blood thinners, specific doctors will treat those conditions accordingly.

How to Prevent Subconjunctival Hemorrhage?

• Do not rub your eyes roughly.

• Cleans contact lens as per the instructions.

• Wear protective gear while playing sports.

• Keep blood conditions under control.

• Maintain sugar and blood pressure levels.

Hyphema

What Are the Causes of Hyphema?

The most common causes are,

• Accidents.

• Injury from sports.

• A fall.

Less common causes include,

• Eye tumor.

• Blood-thinning medications like Warfarin and Aspirin.

• Problems caused by intraocular lenses.

• Abnormal growth of blood vessels (neovascularization).

• Muscle weakness.

• Uveitis (inflammatory condition of the eye).

• Von Willebrand disease (it is a lifelong clotting disorder).

What Are the Symptoms of Hyphema?

• Blurred vision.

• Blood spots are evident in the front part of the eyes.

• Pain.

• Sensitive to light.

• Colored sight, specifically red.

How to Diagnose Hyphema?

The doctor will take a detailed case history to know if any accident or trauma has happened. Patients will be questioned about their medications to see if they are taking blood-thinning drugs like Warfarin and Aspirin.

Patients will also be evaluated for sickle cell anemia as the sickle-shaped blood cells will obstruct the trabecular meshwork (present between the cornea and iris through which aqueous humor is drained), affecting the aqueous humor drainage and resulting in increased intraocular pressure.

Tests:

• Visual Acuity: The patient will be made to sit 6 feet away from the Snellen chart containing alphabets and numbers from bigger to smaller sizes. The patient's vision power will be evaluated by asking the patient to read out the characters in the chart.

• Slit Lamp Test: This test is done to evaluate the layers of the eye for any injury or increased eye pressure. The eyes are focused using a microscope attached to a slit lamp.

• Gonioscopy: Goniolens attached to a slit lamp are used to check if the drainage angle between the cornea and iris is open or close.

• Hemoglobin Electrophoresis: This test is done to find if sickle cell anemia is present or not.

How to Manage Hyphema?

1) Conservative Treatment:

Non-problematic hyphemas can be treated conservatively. Doctors will advise to,

• Use eyeshields.

• Restrict eye movements.

• Maintain the head position at 45° to maintain the blood in the inferior part of the chamber.

A follow-up for two to three days is recommended to keep the eye pressure in check.

2) Medical Management:

• Topical application of aqueous suppressants like beta-blockers and alpha agonists to control the increasing pressure on the eyes is recommended. If it does not come under control, systemic acetazolamide and mannitol are prescribed. If none of this works, surgical intervention is required.

• To control sickle cell activity, hypersomatic drugs are prescribed.

• NSAIDs are a strict no for pain control, as they will increase the bleeding.

3) Surgical Management:

Most of the cases heal with medical management. Few traumatic hyphemas will need surgical intervention.

Procedure: The anterior chamber is irrigated, placing a small incision to aspirate the contents. A new pathway is created to drain the fluid (trabeculectomy). In the case of total hyphema, the pupil gets blocked. So a peripheral iridectomy procedure is done to relieve the pupillary block.

Post-Surgical Complications:

• Rebleeding.

• Obstruction of the trabecular meshwork.

• Optic nerve damage.

• Blood stains the corneal layer.

• Blockage of pupils

Conclusion

Subconjunctival hemorrhage and hyphema may show scary symptoms but are readily manageable. Seeking a doctor's help immediately will help reduce the condition's complications.