A subconjunctival hemorrhage is blood beneath the conjunctiva, with an alarming bright red appearance against the white sclera below (Fig 14-11). Patients with subconjunctival hemorrhage typically have no history of antecedent trauma. When trauma has occurred, damage to deeper structures of the eye (ie, eye perforation when there is massive and raised hemorrhage) must be ruled out. Subconjunctival hemorrhage is usually not associated with an underlying systemic disease and rarely has an identifiable cause. Occasionally, a history of vomiting, coughing, or other forms of the Valsalva maneuver can be elicited. Patients may be taking a medication that impedes clotting.
Figure 14-11 Subconjunctival hemorrhage shows prominently against white sclera.
(Courtesy of Woodford S. Van Meter, MD.)
Typically, no therapy is necessary for the hemorrhage, as it usually resolves in 7–12 days, and the patient simply requires reassurance that the condition is not serious. If the hemorrhage elevates the limbal conjunctiva off of the cornea, corneal dellen may occur. Patients should be warned that the hemorrhage can spread around the circumference of the globe before it resolves and that it may change in color from red to yellow during its dissolution.
Repeated episodes of spontaneous subconjunctival hemorrhage may indicate a possible bleeding diathesis (eg, easy bruising, frequent bloody nose), and a careful systemic medical evaluation may be warranted. Recurrent subconjunctival hemorrhages can be seen in association with uncontrolled hypertension; diabetes mellitus; systemic blood disorders; and use of antiplatelet (aspirin), anticoagulant (heparin or warfarin), and thrombolytic (streptokinase) drugs.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.