A Patient's Guide to Subconjunctival Hemorrhage

7:00 AM

If you've ever looked in the mirror and seen this:

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Thankfully subconjunctival hemorrhages look at lot worse than they truly are in most cases.  Blood is trapped on the surface of the eye due to a broken blood vessel in the conjunctiva (the vascular tissue that overlies the white of the eye). Because the conjunctival tissue is a vascular membrane, blood that leaks gets trapped underneath and can take 1-2 weeks to fully reabsorb.

What Caused This? 
The most common causes for subconjunctival hemorrhage are:
  • coughing, sneezing, straining, heavy lifting, or vomiting These activities acutely raise blood pressure in the veins, causing a small rupture in the capillary bed where arteries and veins connect; it's called a valsalva maneuver.  
  • injury 
  • uncontrolled vascular disorders like diabetes and high blood pressure, anemia, or blood clotting disorders
  • blood thinning medications
  • via
    • Aspirin
    • Warfarin  
    • Coumadin
    • Heparin
    • Plavix
  • nutritional supplements (these also have blood thinning or anti-coagulation properties which can increase the risk of subconjunctival hemorrhage, especially when the patient is already taking other blood thinners, or when they have uncontrolled high blood pressure)
    • Tienchi (Panax notoginseng)
    • Garlic Supplement (Allium sativum)
    • Ginkgo biloba
    • Fish Oil/Omega 3 
    • Bilberry (Vaccinium myrtillus)
  • Less common but possible:
    • abrupt changes in acceleration like sudden braking during a car accident
    • abrupt changes in barometric pressure like scuba diving
    • viral conjunctivitis (acute hemorrhagic conjunctivitis)
    • vascular tumors (cavernous hemangioma, lymphangioma)

What Can I Do To Look Normal Again?
Unfortunately subcojunctival hemorrhages will reabsorb in their own good time.  There is no eye drop or medication that can make them heal faster.  Typically resolution occurs within 1-2 weeks, depending on the size of the hemorrhage.  If the hemorrhage happened at the top of the eye, it may actually look worse before it gets better as gravity brings the trapped blood downwards toward the lower eyelid area.

To potentially speed things up you should:
  • Avoid blood thinners like aspirin or the supplements listed above if possible (it's best to consult with your primary care doctor before changing medication)
  • Avoid intense weight-lifting workouts (heavy lifting can cause another break)
  • Some people report success alternating a cool and warm compress (just held over the closed eye --no rubbing).  Heat can improve circulation to the area and potentially help breakdown clotted blood so it absorbs faster.  Cool compresses can reduce the swelling often associated with an acute hemorrhage by constricting the conjunctiva.
Need a painkiller but have a subconjunctival hemorrhage?  Tylenol and Ibuprofen have reduced risk of blood thinning as a side effect than aspirin.  via

Should I See a Doctor?
Even though a subconjunctival hemorrhage can be a benign finding, there are many conditions that can cause hemorrhages that deserve investigation.  If you've had a recent trauma, you definitely need to see a doctor in case there is an open abrasion or maybe even a deeper injury that needs treatment. Blood pressure should be checked when a subconjunctival hemorrhage appears without history of trauma - a study of 78 patients with spontaneous presentation of subconjunctival hemorrhage (average age 53) showed that 46% of patients with subconjunctival hemorrhage had elevated blood pressure. If you have recurrent subconjunctival hemorrhages, having blood work done to test for dangerous systemic conditions is a good idea.  In addition to checking blood pressure and blood sugar, your doctor may order blood work to rule out anemia, leukemia, and blood clotting disorders like polycythemia. Most of the time subconjunctival hemorrhages are just an annoyance, but they can be a sign of a deeper health problem that is just expressing itself through the eyes.

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