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Subconjunctival Hemorrhage

What is a Subconjunctival Hemorrhage (SCH)?

The conjunctiva is the thin, transparent membrane that covers the white part of the eye and the inside of the eyelids. It is the outermost protective coating of the eyeball. The conjunctiva contains many nerves and small blood vessels. These vessels become more visible if the eye is inflamed. They also are somewhat fragile, and they may break easily resulting in a subconjunctival hemorrhage, bleeding under the conjunctiva. This will appear as a bright red area on the white part of the eye.


What Causes a Subconjunctival Hemorrhage?

Most occur spontaneously, without an obvious cause. Often, you may discover a SCH upon waking and looking in the mirror. Many people report that they first knew they had a SCH after another person saw the red spot and asked “what happened to your eye?” There are a few things however that can potentially cause a SCH.


  • Sneezing

  • Coughing

  • Straining/Vomiting

  • Eye rubbing

  • Trauma

  • Eye surgery (ie. LASIK or cataract surgery)

  • High blood pressure

  • Bleeding disorder (causing bleeding or inhibiting normal clotting)


Signs and Symptoms:

Most of the time, there are no symptoms associated with a subconjunctival hemorrhage.

Very rarely people experience pain when the hemorrhage begins. There could be a sense of “fullness” in the eye or under the lid. As the hemorrhage resolves, some may experience very mild irritation or a sense of awareness of the eye.

The hemorrhage itself is an obvious, sharply outlined red area in the white part of the eye. Sometimes the entire white part of the eye could be covered by blood.

No blood will exit the eye. If you blot the eye with a tissue, there should be no blood on the tissue.

Often the hemorrhage may appear larger over the first 24 hours and then will slowly decrease in size. Sometimes they will obtain a yellowish hue as the blood is absorbed.


Treatment:

Usually, no treatment is needed. Over the counter artificial tears can be used if there is mild irritation present. Unless otherwise directed by your doctor, you should avoid taking aspirin, ibuprofen, naproxen or other non-steroidal anti-inflammatories as these can increase bleeding.

If the SCH is related to trauma your eye doctor will need to examine your eye to rule out the possibility of damage to other parts of the eye.

A SCH will usually resolve itself within 1-2 weeks. Recovery is similar to a mild bruise under the skin. Like a bruise, a SCH can change colors as it heals. If the hemorrhage does not improve within two weeks or if you have had multiple SCH’s you may need to see your doctor. It is important to seek medical care if along with a SCH you have:


  • Pain

  • Change in vision

  • History of a bleeding disorder

  • High blood pressure

  • Injury from trauma to the eye

  • SCH in both eyes at the same time or other symptoms of bleeding, such as easy bruising or bleeding gums

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