Subconjunctival Hemorrhage - A Descriptive Review

What Is Subconjunctival Hemorrhage?

A red area or spot in the eye caused due to damaged blood vessels in the eyes is called a subconjunctival hemorrhage. It is because the blood does not leak from the inside of the eye; instead, the blood oozes from the small blood vessels on the surface of the eye over the sclera (white portion of the eye). The transparent membrane that covers the eye's sclera is called the conjunctiva, and when the blood gets trapped below the conjunctiva, it is called a subconjunctival hemorrhage. The conjunctiva does not absorb the blood, so the blood gets collected and trapped there. This condition is generally harmless and painless. Since the blood does not come from the inside of the eye or the cornea, there is no harm to the vision. Subconjunctival hemorrhage often requires no treatment and disappears within one to two weeks.

What Are the Causes of Subconjunctival Hemorrhage?

Most of the time, the cause of subconjunctival hemorrhage is unknown. However, any day-to-day life activity may cause rupturing of the eyes' blood vessels, resulting in subconjunctival bleeding. The most common cause of subconjunctival hemorrhage in the younger population is trauma or injury to the eyes. The risk of subconjunctival bleeding increases with age and is more prone in older people due to the risk of diabetes or blood pressure. It includes the following causes:

Hemorrhage Caused Due to Sudden Increase in Blood Pressure:

• Coughing and sneezing with great force.

• Vomiting.

• Straining of the muscle while using the toilet.

• Tiring of the eyes due to watching television or excessive use of mobile phones.

Subconjunctival Hemorrhage May Also Result From an Injury or Illness.

• Irritation caused due to rubbing the eyes.

• Irritation to the eyes by contact lens.

• Injury as a result of something hitting the eyes.

• Viral infections.

• Post-surgery.

What Are the Risk Components for Subconjunctival Bleeding?

The risk factors or components for subconjunctival hemorrhage are:

• Diabetes (increased glucose level in the blood).

• Hypertension (increased blood pressure).

• Bleeding disorders.

• Medications like blood thinners (Aspirin and Warfarin).

What Is the Pathophysiology of Subconjunctival Hemorrhage?

Blood vessels of the conjunctiva tear and result in bleeding. The blood leaks into the subconjunctival space resulting in subconjunctival hemorrhage. With increasing age, the elastic and connective tissue gets easily damaged, resulting in subconjunctival hemorrhage. A subconjunctival hemorrhage is a preference for the temporal and inferior side due to the downward movement of the blood.

What Is the Diagnosis of Subconjunctival Hemorrhage?

Doctors can diagnose subconjunctival hemorrhage by looking at the eyes. Then, any history of injury is taken into consideration. The doctor also notes the patient's medical history of blood pressure and diabetes. Finally, the healthcare provider advises a blood test to rule out bleeding disorders.

What Are the Complications of Subconjunctival Hemorrhage?

Serious health complications related to a subconjunctival hemorrhage rarely occur. If the subconjunctival bleeding is due to trauma or injury, further tests are advised to rule out the possibility of other eye problems or damage. Subconjunctival hemorrhage can also indicate disorders like coagulopathy (bleeding disorders), severe orbital trauma, and non-accidental trauma like abuse.

What Is the Treatment of Subconjunctival Hemorrhage?

No treatment is required for a subconjunctival hemorrhage. Eye drops are prescribed in case of irritation of the eyes. The damaged blood vessels heal in two weeks. Due to blood accumulation, large spots take longer to heal and fade away. The patient should take medical help immediately if redness of the eyes is accompanied by pain. Sometimes this can indicate other severe conditions like hyphema (blood collection in the anterior chamber, i.e., the front and the colored portion of the eyes). If subconjunctival hemorrhage occurs often, tests are conducted to recognize the primary cause. Blood disorders like hemophilia and von Willebrand disease make a person more prone to subconjunctival hemorrhage.

How Can Subconjunctival Hemorrhage Be Prevented?

All of us can prevent subconjunctival hemorrhage by being cautious during everyday activities. Eye rubbing should be avoided; if needed, it should be done gently so that the blood vessels do not get damaged. Contact lenses should be regularly cleaned and disinfected. Avoid wearing contact lenses for a longer duration as it irritates the eyes. Protective wear for the eyes should be worn while playing sports or performing activities that can cause damage to the eyes. One should consult doctors to learn about bleeding disorders.

Why Is Patient Education Important in Subconjunctival Hemorrhage?

A subconjunctival hemorrhage is harmless and usually subsides independently without needing medication or medical help. The symptoms typically subside within two weeks. However, if the condition recurs and the patient is on anticoagulant therapy, they should consult a cardiologist immediately. In addition, an ophthalmologist should be consulted.

What Is the Differential Diagnosis for Subconjunctival Hemorrhage?

If Orbital Trauma Is Present:

• Retrobulbar hematoma (accumulation of blood in the retrobulbar space).

• Corneal abrasion.

• Laceration of the conjunctiva.

• Ocular foreign body (a foreign body like dust, wooden speck, etc., present in the eye).

• Traumatic iritis (trauma to the iris).

• Traumatic hyphema (blood present in the eye's anterior chamber).

If Trauma Is Not Present:

• Conjunctivitis (irritation and inflammation of the conjunctiva, which is the membrane covering the white portion or sclera of the eye).

• Episcleritis (inflammation of episcleral tissue, which is a transparent layer above the white portion or sclera of the eye).

• Erosion of the cornea (loss of corneal epithelium).

• Keratitis (inflammation of the cornea resulting in the red eye).

• Anterior uveitis (middle layer of the eye is inflamed).

• Inflamed pterygium.

What Is the Prognosis of Subconjunctival Hemorrhage?

Vision is not generally affected in subconjunctival hemorrhage; hence, the visual prognosis is good once the symptoms (red spot in the eye) subside. However, the chances of recurrence of subconjunctival bleeding are high if the patient has any systemic disorders like diabetes and blood pressure. In addition, the recurrence rate is increased if the patient is on anticoagulants like Aspirin and Warfarin or has bleeding conditions like hemophilia.

Conclusion

A subconjunctival hemorrhage is a widespread complaint observed by doctors. In most cases, there are no symptoms except for the redness of the eyes. In most cases, subconjunctival hemorrhage occurs while performing routine activities. However, sometimes underlying systemic disorders like diabetes and hypertension can be the reason for subconjunctival bleeding. The issue of subconjunctival hemorrhage is first encountered by medical professionals like primary healthcare providers, emergency physicians, and ophthalmologists. A cardiologist should be consulted if the subconjunctival bleeding results from anticoagulants like aspirin and warfarin. Neonatologists and pediatricians should be consulted if present in newborns and children.