Subconjunctival haemorrhage

When small, delicate blood vessels break beneath the tissue covering the white of the eye (conjunctiva), resulting eye redness may mean there is a subconjunctival haemorrhage.

A subconjunctival haemorrhage usually is benign, causing no vision problems or significant eye discomfort despite its conspicuous appearance.

But eye redness also can be a sign of other types of potentially serious eye conditions so all patient’s presenting like this will need a full eye assessment either in the ED or at the Eye Hospital (08:30 – 16:30)

In addition, you should seek advice from a doctor or ENP whenever you triage unusual and persistent redness of the eye accompanied by a sudden change in vision, pain or strong light sensitivity. This type of eye redness can be a sign of other eye problems such as sudden onset of glaucoma.

What Causes Subconjunctival Haemorrhages?

Although it is not always possible to identify the source of the problem, some potential causes of subconjunctival haemorrhage include:

  • Eye trauma
  • A sudden increase in blood pressure that can result from heavy lifting, coughing, sneezing, laughing and constipation
  • Aspirin or blood thinners such as warfarin
  • Rarely, a blood clotting disorder or vitamin K deficiency (vitamin K aids the functioning of proteins necessary for blood clotting)
  • Eye surgery, including cataract surgery
Or barely visible, like this. The treatment is still the same.
Subconjunctival haemorrhages can look severe like this…

How Do We Manage Subconjunctival Haemorrhages in the ED?

Lubricating eye drops over the counter can soothe the eyes, although eye drops cannot help repair the broken blood vessels.

If the patient is taking aspirin or blood thinners, advise that they continue taking them unless their doctor specifically instructs them to do otherwise.

Advise the patient not to rub their eye, which can increase the risk of re-bleeding right after onset — similar to how a nose bleed is susceptible to re-bleeding in the early stages.

There is no direct treatment to resolve the haemorrhage and it will just reabsorb in time. Patient’s will have their visual acuities tested and have an eye exam under a slit lamp. They will be referred to BEH if required but most subconjunctival haemorrhages will not require further treatment.

How Long Do Subconjunctival Haemorrhages Last?

In most cases, it takes seven to 10 days for a subconjunctival haemorrhage to resolve on its own. As the blood gradually disappears with time, the affected area can change colour, like a bruise.

Source: https://www.allaboutvision.com/conditions/hemorrhage.htm

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