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Blood in the Eye - An Overview

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Subconjunctival hemorrhage and hyphema are the common conditions presenting with bloody eyes. Both are caused due to many factors but commonly injury or trauma.

Written by

Dr. Sumithra. S

Medically reviewed by

Dr. Shachi Dwivedi

Published At October 7, 2022
Reviewed AtMay 11, 2023

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.

Frequently Asked Questions

1.

What Causes Blood in the Eye?

The causes include the following:
- Strained vomit, cough, and sneeze.
- Rubbing the eye vigorously.
- Contact lens.
- Viral infection.
- Post-surgical complication.

2.

What Should I Do If My Eye Blood Vessel Bursts?

A subconjunctival hemorrhage occurs without any potential harm to the eye. Even a strong cough or sneeze can cause a blood vessel to rupture in the eye. Emergency care is not needed as it is usually harmless and resolves within two weeks.

3.

What to Do if There Is Bleeding Inside the Eye?

Consult a doctor if there is any eye bleeding or other symptoms related to the eye. Do not ignore any changes in the vision or the eye. It is always recommended to have the eyes checked. As even minor infections can cause complications if left untreated.

4.

Can Stress Lead To Bleeding in the Eye?

A subconjunctival hemorrhage is a common cause of red eyes. Causes include a sudden spike in blood pressure caused by mental and physical stress, or it can be a sign of underlying vascular illness.

5.

Is It an Emergency if There Is Bleeding Inside the Eye?

Bleeding inside the eye is an emergency if there is a broken vessel or other specific conditions. In addition, if the subconjunctival hemorrhage is associated with symptoms such as signs of infection, it requires immediate medical care.

6.

What Are the Ways to Get Rid of Hyphema?

Treatment involves the following:
- Use eyeshields.
- Restrict eye movements.
- The individual must maintain a head position at 45 degrees to maintain blood flow to the inferior chamber.
- Beta-blockers and alpha agonists may be prescribed.
- Surgery.

7.

How Much Time Does It Take Hyphema to Resolve?

Hyphema usually resolves without treatment in a few days. Even if the individual requires conservative treatment, it resolves after five days of treatment. Hyphema can be resolved quickly by limiting eye movement and wearing an eyeshield.

8.

What Are the Causes of Hyphema?

The causes include:
- Accidents.
- Sports injuries.
- Eye tumor.
- Blood thinners.
- Intraocular lenses

9.

Is Hyphema a Life-Threatening Condition

A hyphema is a pooling of blood inside the eye's anterior chamber. It can be an indication of various eye and systemic deficiencies, some of which may be life-threatening. Hence, it is important to get it treated at the earliest.

10.

Is Hyphema Permanent?

Hyphema usually resolves without treatment in a few days. As a result, vision problems are usually temporary. But in rare instances, hyphema may cause permanent damage to the eye and vision if it is not treated soon.

11.

Can the Habit of Rubbing the Eye Cause Hyphema?

Yes, the habit of rubbing the eye can cause minor trauma to the eyes, which causes a subconjunctival hemorrhage or hyphema. Therefore, it is advised to avoid vigorous physical activity and any direct pressure on the eye.

12.

What Are the Home Remedies That Help to Treat Red Eyes?

 
- Place a cool compress over the eyes.
- Avoid eye makeup.
- Use over-the-counter artificial tears.
- Application of antihistamines.
- Avoid smoking

13.

What Is an Eye Hemorrhage?

A subconjunctival hemorrhage occurs when a small blood vessel breaks underneath the eye's clear surface or conjunctiva. It is similar to having a bruise on the skin. It can be treated with eye drops and artificial tears.
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Dr. Shachi Dwivedi
Dr. Shachi Dwivedi

Ophthalmology (Eye Care)

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