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Subconjunctival bleeding, also known as subconjunctival hemorrhage or subconjunctival haemorrhage, is bleeding from a small blood vessel over the whites of the eye. It results in a red spot in the white of the eye. There is generally little to no pain and vision is not affected. Generally only one eye is affected. and both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males. Generally no specific treatment is required and the condition resolves over two to three weeks. Artificial tears may be used to alleviate irritation. The affected eye may feel dry, rough, or scratchy, but the condition is not usually painful.

Causes

  • Mechanical
  • Increased venous pressure (e.g. extreme g-force, straining, vomiting, choking, sneezing, coughing or strangling)
  • Atmospheric pressure changes due to aircraft altitude changes
  • Mask squeeze from scuba diving without equalizing mask pressure during descent
  • Eye injury or eye surgery
  • Zygoma fracture (results in lateral subconjunctival bleeding)
  • Medical conditions that affect blood or blood vessels:
  • Severe hypertension
  • Viral hemorrhagic fever
  • Coagulation disorder (congenital or acquired)
  • Acute hemorrhagic conjunctivitis (caused by including enterovirus 70, coxsackievirus A24 variant, and adenovirus 11)
  • Leptospirosis

Subconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency),<!-- -->

abuse or traumatic asphyxia syndrome.

Diagnosis

Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. In rare cases blood may drip from the eye.

Management

A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged.

References