Recurrent subconjunctival hemorrhage is repeated bleeding from conjunctival vessels into the space between the conjunctiva and sclera. It is usually benign, but recurrence suggests an underlying cause.

Causes are hypertension, diabetes, bleeding disorders, anticoagulant or antiplatelet therapy, thrombocytopenia, contact lens wear, conjunctivochalasis and repeated straining or coughing.
Infectious causes include haemorrhagic conjunctivitis and malaria.
Many cases have no cause.

Painless, bright red patch on the white of the eye with clear margins, which may enlarge over 24 hours and fades through yellow over 1 to 2 weeks.

Vision is normal and the red patch does not involve the cornea.
Differential diagnosis: conjunctivitis, episcleritis, scleritis, Kaposi sarcoma, conjunctival melanoma, lymphoma, blood dyscrasia, vascular malformation.
Complications: usually none, but repeated bleeding may signal hypertension, coagulopathy or leukaemia.

Reassure and treat the cause.

Supportive: avoid eye rubbing, cold compresses for the first 24 hours then warm compresses, avoid straining, review contact lens hygiene.
Pharmacological: lubricating drops such as carboxymethylcellulose 0.5 percent four times daily for comfort; paracetamol 1 g if pain; treat hypertension to target; adjust warfarin to the target INR; stop NSAIDs and aspirin if not needed; vitamin K 10 mg IV or orally for a high INR with bleeding as directed by clinical need.
Procedures: surgical conjunctival resection for conjunctivochalasis in recurrent disease.
Special groups: pregnancy, check blood pressure and exclude pre eclampsia; infants, consider non accidental injury; diabetes, optimise glucose and examine the fundus.
Red flags: pain, reduced vision, bleeding at multiple sites, trauma, posterior extent not visible, bruising, petechiae.
Follow-up: review in 2 weeks; refer to haematology or a physician if recurrent without cause.

Recurrent Subconjunctival Hemorrhage

Overview

Clinical Features

Diagnosis

Management