Subconjunctival Hemorrhage

Rupture of small vessels leading to an accumulation of blood in the subconjunctiva, the potential space between the conjunctiva and the sclera

Synonym(s): Conjunctival hemorrhage

Sudden increase in ocular pressure, which may result from coughing, sneezing, vomiting, or straining

Uncontrolled HTN

Acute conjunctivitis

Vigorous eye rubbing

Aspirin or other anticoagulant use

Underlying hematologic or systemic disease

No visual changes

Eye trauma, including rubbing

Use of aspirin or other anticoagulant

Medical conditions leading to increased intraocular pressure or straining, including uncontrolled HTN, constipation, prostatic hypertrophy, cough, sneezing, and vomiting

Exercise or activities involving exertional straining (ie, weightlifting, etc.)

Diagnosis of or symptoms suggestive of bleeding disorders, such as easy bruising, menorrhagia, etc.

Asymptomatic

Extreme redness of eye without change in vision

Extensive subconjunctival hemorrhage may cause a protruding sac of blood, possibly beyond the lid margin.

Bright red area of blood, either focally or diffusely in potential space under conjunctiva

BP measurement to evaluate for uncontrolled HTN (1)[C]

Stigmata of bleeding or other hematologic disorders (petechiae, bruising, etc.)

Associated signs suggestive of acute hemorrhagic conjunctivitis

Acute hemorrhagic conjunctivitis: A highly contagious disease caused by enterovirus 70 and coxsackievirus A24. Pain, photophobia, blurred vision, and epiphora develop acutely, with 80% developing bilateral disease within 24 hr. Ocular signs may include subconjunctival hemorrhage as well as discharge, punctate corneal epithelial keratitis, and lid edema. Patients also may complain of fever, headache, upper respiratory infection symptoms, and myalgia, and may have tender preauricular lymphadenopathy. Symptoms usually resolve without treatment over 5–7 days, with persistent subconjunctival hemorrhages resolving over an additional 1–2 wks.

Scleral rupture should be suspected in a posttraumatic patient with a bullous subconjunctival hemorrhage, especially in the presence of blood in the vitreous, decreased intraocular pressure, or a shallow anterior chamber.

Orbital hemorrhage may present with massive subconjunctival hemorrhage as well as proptosis and limitation of extraocular movements, usually after trauma.

Infrequently, adenoviral conjunctivitis, bacterial conjunctivitis, and even allergic conjunctivitis may present with an associated subconjunctival hemorrhage.

Consider ophthalmology consultation if history of ocular trauma is present or in the presence of associated ocular injury.

Consider hematology consultation if hemorrhages are idiopathic and recurrent.