SYMPTOMS

What is subconjunctival hemorrhage?

The bulbar conjunctiva (commonly referred to as the "white of the eye") is a transparent mucosal tissue covering the outer surface of the sclera in the anterior one-third of the eyeball.

The bulbar conjunctiva has abundant and fine blood vessels, with more veins than arteries, and the external pressure on these vessels is usually low. When there is a sudden increase in intravascular or extravascular pressure (e.g., due to coughing or sneezing), the vessel walls may rupture or their permeability may increase, causing blood to accumulate beneath the conjunctiva. This results in subconjunctival hemorrhage, manifesting as a patchy red area on the white of the eye.

Possible causes include trauma, such as scratches or punctures from hard objects, or secondary conditions like conjunctivitis, hypertension, arteriosclerosis, diabetes, or coagulation disorders. However, spontaneous hemorrhage is more common, particularly in the elderly, and may be triggered by heavy lifting, coughing, constipation, sneezing, or other factors^[1,2].

Are the bulbar conjunctiva and conjunctiva the same thing?

No. The bulbar conjunctiva is only one part of the conjunctiva, which also includes the palpebral conjunctiva and the fornix conjunctiva^[3].

Is subconjunctival hemorrhage common?

Yes. Subconjunctival hemorrhage is positively correlated with age. As society ages, it has become a common condition in ophthalmology. People aged 50 and above are particularly susceptible because they are more likely to have chronic conditions like diabetes and hypertension, which are high-risk factors for subconjunctival hemorrhage^[4].

Most cases are asymptomatic and are often discovered accidentally when looking in a mirror or noticed by family or friends.

Are subconjunctival hemorrhage and retinal hemorrhage the same thing?

No.

Retinal hemorrhage is not a single disease but may result from various conditions. It refers to the rupture or increased permeability of blood vessels in the retina or choroid, leading to blood accumulation in these areas. The bleeding is not visible externally. In contrast, subconjunctival hemorrhage specifically involves small blood vessels in the bulbar conjunctiva rupturing or becoming more permeable, causing blood to pool beneath the conjunctiva, which is visibly seen as redness in the white of the eye^[2].

TREATMENT

How to relieve subconjunctival hemorrhage?

1. Cold and warm compresses: Generally, subconjunctival hemorrhage does not require special treatment. Within 24 hours of the hemorrhage, a cold compress can be applied to the eyelids to promote clotting. After 48 hours, a warm compress can be used to help absorb the blood. Apply the compress 3 times a day for 10–15 minutes each time. When using a warm compress, ensure the temperature is not too high—around 40–50°C is ideal.
2. Use of eye drops: If there is mild discomfort or a foreign body sensation without other eye symptoms, artificial tears can be tried to alleviate the discomfort.
3. Avoid anticoagulants: Avoid using anticoagulants such as aspirin. If you are undergoing anticoagulant therapy, consult a doctor to decide whether to continue or discontinue the medication^[5].

Can subconjunctival hemorrhage cause blindness or vision loss?

Subconjunctival hemorrhage usually does not lead to vision loss and will not cause blindness^[4].

Subconjunctival hemorrhage is self-healing. If it is caused by an underlying condition, a doctor can assess whether it may affect vision based on the severity of the primary disease and the extent of bleeding.

Are there any sequelae from subconjunctival hemorrhage?

In most cases, there are no sequelae. Simple subconjunctival hemorrhage tends to heal on its own without special treatment.

If there is an underlying condition, actively treat it, as sequelae are often caused by the primary disease. Maintain eye hygiene and avoid rubbing the eyes with hands or foreign objects to prevent infection^[4].

How long does it take for subconjunctival hemorrhage to heal?

Typically, the blood is absorbed, and the eye returns to normal within 1–2 weeks^[1].

How to prevent subconjunctival hemorrhage?

1. Reduce the use of contact lenses and clean and disinfect them regularly.
2. Maintain a regular routine, use eyes scientifically, and reduce screen time.
3. Protect the eyes during intense physical activities by wearing protective gear to avoid trauma-induced subconjunctival hemorrhage.
4. If bleeding is caused by anticoagulant medication, seek medical guidance for proper treatment.
5. Practice good eye hygiene, avoid rubbing the eyes with hands, and if necessary, do so gently^[4].

How can diabetic and hypertensive patients prevent subconjunctival hemorrhage?

Diabetic and hypertensive patients can take the following measures to prevent subconjunctival hemorrhage:

1. Actively manage the underlying condition.
2. Maintain eye hygiene, avoid rubbing the eyes, and clean and disinfect contact lenses regularly.
3. Stay calm and avoid extreme emotional fluctuations.
4. Reduce intense physical activities (such as football or rugby) and sudden exertion (e.g., lifting heavy objects or straining during constipation)^[1,4].

DIAGNOSIS

When should I seek medical attention for subconjunctival hemorrhage?

1. If symptoms of subconjunctival hemorrhage do not improve after 15 days, you should visit the hospital.
2. If subconjunctival hemorrhage occurs in both eyes simultaneously, accompanied by other bleeding symptoms such as skin bruising or gum bleeding, you should visit the hospital.
3. If subconjunctival hemorrhage is accompanied by eye pain, dizziness, vision loss, or is caused by trauma, you should seek immediate medical attention.

In most cases, subconjunctival hemorrhage will resolve within 1–2 weeks. If the bleeding does not improve or recurs frequently, you should visit the hospital to identify the underlying cause^[1,5].

Which department should I visit for subconjunctival hemorrhage?

Ophthalmology.

POTENTIAL DISEASES

What are the possible causes of subconjunctival hemorrhage?

The incidence of subconjunctival hemorrhage is positively correlated with age and is more common in middle-aged and elderly people over 50 years old. It may be related to reduced elasticity of blood vessel walls and increased pressure on conjunctival blood vessels due to chronic diseases such as hypertension with aging.

Most subconjunctival hemorrhages are spontaneous with no obvious triggers. Forceful sneezing, coughing, vomiting, constipation, heavy lifting, hypertension, bleeding disorders (e.g., allergic purpura, thrombocytopenia), trauma, or eye rubbing may cause subconjunctival hemorrhage. It may also be associated with the following factors:

1. Medications: The use of anticoagulants such as aspirin can increase the likelihood of subconjunctival hemorrhage. Long-term use of anticoagulant or antiplatelet drugs may also lead to subconjunctival hemorrhage.
2. Trauma: Eye trauma is a major cause of subconjunctival hemorrhage in men, such as scratches or punctures from hard objects.
3. Contact lens wear: Mechanical damage like abrasions may occur during lens insertion, and long-term wear can contribute to dry eye syndrome or conjunctival infections^[1,4].

Why does subconjunctival hemorrhage occur frequently?

Frequent subconjunctival hemorrhage, after excluding repeated head or eye trauma, requires investigation for underlying conditions such as diabetes, hypertension, or bleeding disorders. These chronic diseases can reduce vascular elasticity and impair coagulation function, leading to recurrent subconjunctival hemorrhage^[1].