Understanding Subconjunctival Haemorrhage and Its Implications

Seeing what seems like blood in your eye can be alarming, it may look like your eye is full of blood, prompting concern. According to the National Eye Institute, even seemingly insignificant incidents can lead to vessel ruptures, as the conjunctiva and underlying vessels are very sensitive to pressure changes. While these hemorrhages may seem concerning due to their appearance, they rarely require medical treatment unless accompanied by other symptoms.

Understanding what it is, its causes, and when to consult an eye doctor can help ease fears and ensure your eye health remains a priority.

When Is Subconjunctival Haemorrhage an Emergency?

While often benign, subconjunctival hemorrhage can sometimes indicate a serious underlying issue or require immediate attention due to associated symptoms. Seek emergency care in the following situations:

• Eye Pain: Significant discomfort alongside blood in the eye could suggest conditions like hyphema or uveitis, requiring prompt treatment.
  
• Persistent Bleeding: If the hemorrhage persists beyond two weeks without improvement, consult an eye care professional to investigate underlying health issues.
  
• Vision Changes or Loss: Any changes in vision or episodes of vision loss accompanying the hemorrhage demand immediate medical attention, as they may indicate severe conditions like retinal detachment or optic nerve damage.
  
• Recurrent Episodes: Repeated occurrences, especially in children and the elderly, can signify systemic conditions like hypertension or diabetes. Frequent episodes in children may also hint at trauma, including non-accidental injuries.
  
• Trauma or Injury: Hemorrhages following eye injury or trauma require immediate intervention due to the risk of concurrent severe eye injuries like orbital fractures or globe rupture.
  
• Blood in the Pupil: Blood pooled in the pupil area (hyphema) can increase intraocular pressure and harm vision, making it a medical emergency.
  
• Pus, Swelling, or Fever: These symptoms, along with subconjunctival hemorrhage, suggest infection or inflammation, possibly conjunctivitis or cellulitis, warranting a thorough medical examination.
  

If you or a loved one experiences any of these emergency situations, contact us to schedule an eye exam with our eye doctors.

Symptoms of Subconjunctival Hemorrhage

A subconjunctival hemorrhage typically presents as a bright red or dark patch on the white part of the eye, caused by blood leaking from a ruptured blood vessel. Despite its alarming appearance, it usually doesn’t cause pain, vision changes, or discharge. Most people remain unaware of the hemorrhage until they look in the mirror or someone else points it out. In some cases, there might be mild irritation or a feeling of pressure in the eye. The red patch doesn’t spread but may change color as it heals, transitioning from red to yellow or green, similar to a bruise. Symptoms generally resolve within one to two weeks without treatment.

Causes of Subconjunctival Hemorrhage: Understanding the Underlying Factors

A subconjunctival hemorrhage occurs when small blood vessels beneath the conjunctiva, the clear tissue covering the white part of the eye, break and leak blood. While this condition often looks alarming due to the bright red or bloodshot appearance it creates, it is usually harmless and resolves on its own within one to two weeks. 

Subconjunctival hemorrhage can occur for several reasons, ranging from minor eye irritation to more serious underlying health conditions. In most cases, it results from everyday actions or situations that cause increased pressure in the blood vessels, but there are also risk factors that may predispose an individual to this condition. 

Sudden Increase in Pressure

One of the most common causes of subconjunctival hemorrhage is a sudden increase in blood pressure in the small, delicate vessels of the eye. This can occur due to:

• Coughing or Sneezing: These sudden, forceful actions can increase pressure in the blood vessels around the eyes.
• Heavy Lifting or Straining: Physical exertion that leads to straining can also cause these tiny blood vessels to rupture.
• Vomiting: The intense physical stress from vomiting can lead to a subconjunctival hemorrhage.

Eye Injuries or Trauma 

Direct injury to the eye, even minor ones, can result in subconjunctival hemorrhage. This includes:

• Rubbing the Eyes Vigorously: Friction from rubbing the eyes too hard can cause small blood vessels to burst. Frequent eye rubbing due to allergies can weaken blood vessels over time, making them more likely to burst.
• Blunt Trauma to the Eye: Accidents or incidents that involve impact to the eye area may cause hemorrhaging.
  

Medical Conditions 

Several underlying health issues can increase the likelihood of developing a subconjunctival hemorrhage, particularly those affecting blood circulation and pressure:

• High Blood Pressure (Hypertension): Chronic high blood pressure can weaken the blood vessels in the eyes, making them more prone to rupturing. According to the American Academy of Optometry, hypertension is a significant risk factor for recurrent subconjunctival hemorrhages.
• Diabetes: Diabetes can lead to changes in blood vessel integrity, increasing the risk of vessel rupture in the eye.
• Blood Clotting Disorders: Conditions that affect the blood’s ability to clot, such as hemophilia or the use of anticoagulants (blood thinners like aspirin or warfarin), can make the eye’s blood vessels more susceptible to bleeding.

Certain Medications 

Medications that affect blood clotting and circulation can be a contributing factor to subconjunctival hemorrhage:

• Anticoagulants and Blood Thinners: Drugs such as aspirin, warfarin, and other anticoagulants decrease the blood’s ability to clot, making it easier for small blood vessels to burst.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Common over-the-counter medications like ibuprofen can increase the likelihood of bleeding.

Other Common Causes of Burst Blood Vessels

• Aging As people age, their blood vessels become more fragile and more susceptible to rupturing, leading to a higher incidence of subconjunctival hemorrhages among older individuals. 

• Eye Surgery or Procedures Surgical interventions involving the eyes, such as cataract surgery, LASIK, or other procedures, can sometimes cause subconjunctival hemorrhages as a side effect of the operation. 
• Infections Certain viral or bacterial infections may increase eye inflammation, making the blood vessels more prone to rupture.

• Sudden Changes in Air Pressure: Rapid changes in altitude or pressure, such as during air travel, can lead to vessel rupture.
• Eye Irritation: Prolonged use of contact lenses or exposure to environmental irritants like smoke or dust can strain the eyes, leading to blood vessel rupture.

Differential Diagnosis: Recognizing Other Causes of Red Eye

While a subconjunctival hemorrhage often resolves on its own, it’s crucial to distinguish it from other conditions that might require urgent care:

• Conjunctivitis: Often confused with SCH, conjunctivitis causes redness with pain and discharge, while SCH is typically painless.
• Ciliary Injection: Characterized by redness around the iris, ciliary injection may indicate serious conditions like iritis or acute glaucoma, needing immediate attention.
• Orbital Trauma and Rupture: A traumatic SCH combined with eye pain or vision changes could suggest a more severe injury, such as an orbital fracture or globe rupture, both requiring urgent care.

Causes of Subconjunctival Hemorrhage: More Detailed Insights

Subconjunctival hemorrhage is generally benign, but certain lifestyle factors and health conditions can increase its frequency or severity:

• Increased Vascular Fragility: Aging and conditions like hypertension or diabetes can weaken blood vessels, making them prone to rupture.
• Medication Effects: Blood-thinning medications, including warfarin, aspirin, and NSAIDs, can heighten the risk of SCH even with minimal trauma.
• Underlying Disorders: Conditions affecting clotting, like hemophilia, or blood vessel integrity, such as Steven-Johnson syndrome or Kaposi’s sarcoma, may increase susceptibility to SCH.

Management and Treatment Options

Most subconjunctival hemorrhages resolve within one to two weeks without specific treatment. However:

• Supportive Measures: Ice packs and artificial tears can provide comfort and reduce swelling.
• Follow-up for Persistent Cases: If SCH persists or recurs, further testing may be needed to assess for clotting disorders or vascular issues.

When Should You Visit An Eye Doctor For A Burst Blood Vessel? 

While most subconjunctival hemorrhages are harmless and resolve without intervention, it is essential to consult a healthcare provider if:

• The hemorrhage is accompanied by pain, changes in vision, or discharge.
• It occurs frequently or without a clear cause, which could indicate an underlying medical condition like hypertension or a blood disorder.

What is The Benefit of a Comprehensive Eye Exam?

While subconjunctival hemorrhage does not require an eye exam, consulting with an eye doctor can be beneficial for peace of mind and to rule out any underlying conditions. If you are concerned about a burst blood vessel, bring it up with your eye doctor during your annual eye exam or schedule a comprehensive eye exam to ensure that you are taking a proactive approach to your vision and eye health. 

Your Eye Health Is In the Right Hands 

Subconjunctival hemorrhages are usually caused by minor issues like increased pressure from sneezing, coughing, or eye rubbing. However, other factors like trauma, medications, and medical conditions can also play a role.