II. Pathophysiology

  1. Bleeding from small Conjunctival vessels

III. Causes

  1. Minor Eye Trauma
  2. Spontaneously with increased venous pressure
    1. Coughing
    2. Sneezing
    3. Vomiting
    4. Straining
  3. Blood dyscrasia (uncommon)
    1. Warfarin
  4. Severe Hypertension

IV. Symptoms

  1. No Eye Pain
  2. Vision normal
  3. Pupil size and reactivity are normal

V. Precautions

  1. Exclude Globe Rupture when Subconjunctival Hemorrhage is Traumatic
    1. Consider with high velocity projectiles (e.g. grinding)
  2. Carefully evaluate diffuse Subconjunctival Hemorrhage (circumferential involving full 360 degrees)
    1. Associated with more serious Eye Trauma (e.g. periorbital Fracture, Retrobulbar Hematoma, Bleeding Disorder)

VI. Labs

  1. ProTime (PT/INR)
    1. Indicated if Subconjunctival Hemorrhage occurs in a patient on Warfarin (Coumadin)

VII. Management

  1. Careful exam including vision
    1. Eye Trauma resulting in bleeding requires an intensive evaluation
    2. Confirm no signs of Globe Rupture
  2. Reassurance
  3. Cold compresses
  4. Artificial tears
  5. Referral for question of greater injury (especially if Traumatic Eye Injury)

VIII. Course

  1. Hemorrhage clears spontaneously in 1-2 weeks

IX. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21

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Related Studies

Ontology: Subconjunctival hemorrhage (C0038534)

Concepts Pathologic Function (T046)
ICD10 H11.3
SnomedCT 155166004, 78768009
Dutch subconjunctiva hemorragie, subconjunctivabloeding, bloeding; subconjunctivaal, subconjunctivaal; bloeding
French Hémorragie sous-conjonctivale
German subkonjunktivale Blutung
Italian Emorragia sottocongiuntivale
Portuguese Hemorragia subconjuntival
Spanish Hemorragia subconjuntival, hemorragia subconjuntival (trastorno), hemorragia subconjuntival
English Subconjunctival hemorrhage, subconjunctival hemorrhage, subconjunctival hemorrhage (physical finding), subconjunctival hemorrhage (diagnosis), hemorrhages subconjunctival, Haemorrhage;subconjunctival, hemorrhage subconjunctival, bleeding subconjunctival, Subconjunctival haemorrhage (disorder), Subconjunctival haemorrhage, Subconjunctival bleed, Subconjunctival hemorrhage (disorder), hemorrhage; subconjunctival, subconjunctival; hemorrhage, Subconjunctival Hemorrhage, subconjunctival haemorrhage, Hemorrhage;subconjunctival
Japanese 球結膜下出血, キュウケツマクカシュッケツ
Czech Subkonjunktivální krvácení, Subkonjunktivální hemoragie
Hungarian Subconjunctivalis vérzés