There are no specific symptoms of this disease. The affected eye is slightly irritated. There should not be any problem in the vision. Eye pain is felt very rarely in subconjunctival hemorrhage. There might be a feeling of fullness under the eyelid. As the condition resolves gradually, mild irritation and a sense of eye awareness can be experienced by the patient. Occasionally, the entire white area is covered by the blood and usually, a patch of redness is observed in the eye. In a spontaneous subconjunctival hemorrhage, no blood is expressed out of the eye; therefore, no blood is blotted on to a tissue when applied on the eye. 

• Pain

  The patch does not cause pain and there is no discharge from the eye. Vision does not change. The health care provider will perform a physical exam and look at your eyes. Blood pressure should be tested. [nlm.nih.gov]

  A subconjunctival hemorrhage should not cause pain or vision problems. [collincreekvision.com]

  Such symptoms could be eye or face pain, trouble seeing, a swollen eye, or blood inside your eyeball. Doctors don’t treat a subconjunctival hemorrhage because it goes away on its own. NOTE: This is the Consumer Version. [merckmanuals.com]

  Red and painful eye. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 22. [mountsinai.org]

• Asymptomatic

  […] the underlying associated systemic etiology of the conjunctival hemorrhage Prescribe a treatment program to treat the underlying condition Patient History Patients usually come in because they notice the bleeding in the conjunctiva, but are otherwise asymptomatic [decisionmakerplus.net]

  It is usually asymptomatic. The patient may not be aware of its presence but it has been reported to them by family or friends, who can find its appearance quite alarming. The patient may have mild irritation. [patient.info]

  Subconjunctival Hemorrhage may often be asymptomatic. [dovemed.com]

• Fever

  typhoid fever, cholera, rickettsia, malaria, and viral infections (eg, influenza, smallpox, measles, yellow fever, and sandfly fever). [emedicine.com]

  A fever. You see blood over the black part of your child's eye (pupil). Your child has any changes in or problems with vision. Your child has any pain in the eye. [myhealth.alberta.ca]

• Ecchymosis

  Ophthalmologica 1990; 200: 63–7Fukuyama, J Hayasaka, S Yamada, K Setogawa, T Paysse EA, Coats DK: Bilateral eyelid ecchymosis and subconjunctival hemorrhage associated with coughing paroxysms in pertussis infection. [anesthesiology.pubs.asahq.org]

• Surgical Procedure

  These groups want to curtail VA optometrists from performing some laser surgical procedures. But the wording of this bill now goes further than that. [forums.studentdoctor.net]

• Cough

  […] or other extreme sneezing or coughing Severe hypertension LASIK Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus) Leptospirosis Ebola Increased venous pressure (e.g., extreme g-force, straining, vomiting, choking, or coughing [en.wikipedia.org]

  It might also occur due to extensive rubbing, sneezing, coughing or vomiting. [symptoma.com]

  A person can choose to cough (a voluntary process), or the body may cough on its own (an involuntary process). [emedicinehealth.com]

  Subconjunctival hemorrhages usually result from minor local trauma, straining, sneezing, or coughing; rarely, they occur spontaneously. The extent and location of hyperemia can help determine etiology. [merckmanuals.com]

• Sneezing

  Such a hemorrhage may be caused by a sudden or severe sneeze or cough, or due to high blood pressure or as a side effect of blood thinners such as aspirin or warfarin. [en.wikipedia.org]

  Subconjunctival hemorrhages usually result from minor local trauma, straining, sneezing, or coughing; rarely, they occur spontaneously. The extent and location of hyperemia can help determine etiology. [merckmanuals.com]

  Sometimes this blood vessel breakage can be caused by a strong cough, vomiting, lifting something heavy, constipation strain, a stong sneeze etc. This “trapped” blood usually takes about 7-14 days to clear up. [visionaryeyecare.wordpress.com]

• Vomiting

  It may also be caused by heavy lifting, vomiting, or even rubbing one's eyes too roughly. In other cases, it may result from being choked or from straining. Also, it can result as a minor post-operative complication in eye surgeries such as LASIK. [en.wikipedia.org]

  Causes Minor eye trauma Spontaneously with increased venous pressure Strenuous Exercising Coughing Touching/widening eyes Sneezing Pulling extreme g-forces Vomiting, particularly forced vomiting as seen in bulimia nervosa Straining Severe alcohol intoxication [wikidoc.org]

  Sometimes this blood vessel breakage can be caused by a strong cough, vomiting, lifting something heavy, constipation strain, a stong sneeze etc. This “trapped” blood usually takes about 7-14 days to clear up. [visionaryeyecare.wordpress.com]

  It might also occur due to extensive rubbing, sneezing, coughing or vomiting. [symptoma.com]

• Constipation

  Critical Essential Core Tested Community Questions (3) (M2.OP.36) A 63-year-old man with chronic constipation presents to his primary care physician complaining of blood in his eye. He noticed that his eye was red when he awoke this morning. [medbullets.com]

  Sometimes this blood vessel breakage can be caused by a strong cough, vomiting, lifting something heavy, constipation strain, a stong sneeze etc. This “trapped” blood usually takes about 7-14 days to clear up. [visionaryeyecare.wordpress.com]

  In other cases, it may result from straining due to constipation. Also, it can result as a minor post-operative complication in eye surgeries such as LASIK. [napergrove.com]

  […] coughing Severe hypertension LASIK Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus) Leptospirosis Ebola Increased venous pressure (e.g., extreme g-force, straining, vomiting, choking, or coughing) or from straining due to constipation [en.wikipedia.org]

• Choking

  In other cases, it may result from being choked or from straining. Also, it can result as a minor post-operative complication in eye surgeries such as LASIK. [en.wikipedia.org]

  The following circumstances can result in a subconjunctival hemorrhage: Coughing Sneezing Vomiting Vigorous eye rubbing Choking Trauma to the eye or head Ocular or eyelid surgery Viral eye infection Subconjunctival hemorrhages are mostly considered to [decisionmakerplus.net]

• Hypertension

  The most common causes for the condition were minor local trauma, systemic hypertension, and acute conjunctivitis. [ncbi.nlm.nih.gov]

  Keywords: subconjunctival hemorrhage, contact lens, hypertension, red eye This work is published and licensed by Dove Medical Press Limited. [dovepress.com]

• Bleeding Gums

  If you have a hemorrhage in both eyes at the same time or the subconjunctival hemorrhage coincides with other bleeding, including easy bruising, bleeding gums or both. [wkeyeinstitute.com]

  If you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with other symptoms of bleeding, including easy bruising, bleeding gums, or both, contact your health care provider or eye care provider. [webmd.com]

  If a subconjunctival hemorrhage does not show signs of clearing within a few days, if you have had multiple subconjunctival hemorrhages, or if you have other symptoms of bleeding (including easy bruising, bleeding gums, or blood in the stools or urine [emedicinehealth.com]

  Also, call your health care provider if you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with a new onset of easy bruising or bleeding gums. [medicinenet.com]

• Flushing

  To remove any foreign body from the eyes, it is advised to flush the eye gently with water or by using artificial tears. Wearing goggles can prevent any dust particles from entering into the eyes. [symptoma.com]

  If you suspect there’s something in your eye, flush it out with your own tears or artificial tears rather than using your fingers. Always wear protective goggles when recommended to avoid getting particles in your eyes. [healthline.com]

• Fracture

  Initial radiological findings were normal in case 1 but multiple healing rib fractures were identified when the chest X-ray was repeated 3 weeks later. [ncbi.nlm.nih.gov]

  Usually this disappears within 2 weeks.Although its appearance may be alarming, in general a subconjunctival bleeding is a painless and harmless condition; however, it may be associated with high blood pressure, trauma to the eye, or a base of skull fracture [en.wikipedia.org]

  Costochondral junctions of the first 6 or 8 thoracic ribs may be expanded; this change may be related to fracturing of the zone of provisional calcification during normal respiration. [emedicine.com]

  It is worth noting that a haemorrhage without a posterior margin (ie extends posteriorly so that the whole extent of the haemorrhage cannot be seen) may be associated with an intracranial bleed or an orbital roof fracture (associated with a black eye) [patient.info]

• Contusion

  Realize, too, that SCH may be a presenting sign of domestic violence, particularly in women and children. 6 Be especially suspicious of bilateral SCH in younger patients or in women who have repeated SCH and contusions/lacerations of the orbit and face [reviewofoptometry.com]

• Eye Pain

  Your eye has red lines or patches in the normally white sclera, or the whole sclera may become red. Your eye may feel slightly scratchy. If you have eye pain or changes in your vision, the redness may be caused by a more serious problem. [kirkeyecenter.com]

  The hemorrhage shouldn’t affect your eyesight or cause any pain. If you do have pain, you may have another type of problem with your eye. Diagnosing subconjunctival hemorrhage Your healthcare provider will ask about your health history. [fairview.org]

  The affected eye is slightly irritated. There should not be any problem in the vision. Eye pain is felt very rarely in subconjunctival hemorrhage. There might be a feeling of fullness under the eyelid. [symptoma.com]

  This condition typically causes redness in one of your eyes. The affected eye may feel slightly irritated. Usually, there aren’t other symptoms. You shouldn’t experience any changes in your vision, any eye pain or discharge. [healthline.com]

• Conjunctival Injection

  Patient 1 had bilateral conjunctival injection and subconjunctival hemorrhage; patients 2-4 had conjunctival injection and episcleral vessel dilation bilaterally. [ncbi.nlm.nih.gov]

  Conjunctival injection mainly affects the posterior conjunctival blood vessels. [emedicine.com]

  Differential diagnosis Other causes of acute red eye, including: Conjunctivitis Episcleritis Uveitis Acute angle-closure glaucoma Keratitis If it is a persistent haemorrhage (as opposed to the conjunctival injection seen in a red eye), consider rarer [patient.info]

• Irritability

  If the eyes are irritated, artificial tears are recommended to be used more than once a day. Artificial tears will provide soothing effect to the eyes. [symptoma.com]

  Prescription antibiotic eye drops can be effective at treating infection, but they can also be quite irritating to the eye and may cause prolonged irritation and redness. [richmondeye.com]

  If your eye is irritated, you can use soothing over-the-counter artificial tears to relieve any discomfort. There is no known way to prevent a subconjunctival hemorrhage from occurring. [beacheye.com]

  Over-the-counter artificial tears can be applied to the eye if mild irritation is present. Do not try using redness reliever (decongestant) eyedrops. [emedicinehealth.com]

  Sometimes the eye may feel a little bit “scratchy” or irritated but, that is usually rare. [visionaryeyecare.wordpress.com]

Diagnosis of subconjunctival hemorrhage is done primarily by the examination of eye and by identifying the cause of the hemorrhage such as any injury or presence of any foreign body [8].

The blood pressure of the patient is checked after inspecting the eye. Blood tests are done to detect if there are any bleeding disorders in the patient. These tests are mostly done if the patient had more than one episode of bleeding beneath the conjunctiva. If eye trauma is the cause of bleeding, then specific analysis and examination with the help of slit lamp or eye examining microscope is performed [9].

Usually, subconjunctival hemorrhage resolves on its own and no treatment is necessary. If the eyes are irritated, artificial tears are recommended to be used more than once a day. Artificial tears will provide soothing effect to the eyes. Drugs that might increase the risk of bleeding (like warfarin and aspirin) are stopped after doctor’s consultation if the patient was already using them. If the cause of subconjunctival hemorrhage is high blood pressure or any bleeding disorder, then treatment for these conditions is also needed. In 1 to 2 weeks, the blood under the thin layer gets absorbed and the eye returns to normal [10].

This condition is quite harmless and the prognosis is good. Subconjunctival hemorrhage is a benign condition and is self-limiting if it is not accompanied by any other systemic ailments [7].

Subconjunctival hemorrhage occurs as a result of a minor trauma to the eye. It might also occur due to extensive rubbing, sneezing, coughing or vomiting. Some of the potential reasons for subconjunctival hemorrhage are sudden elevation in blood pressure due to an intense activity such as heavy object lifting, eye trauma, using drugs like aspirin and warfarin, vitamin K and C deficiency or a clotting disorder. Infections such as influenza and malaria, parasitic infestations, and diseases like systemic lupus erythematosus are also considered to be causative factors for this disease [2] [3].

Epidemiological data indicates that subconjunctival hemorrhages are observed in 0.8% of patients. They also seem to occur more frequently in women compared to the men. A study revealed that this condition was found unilaterally in 90 percent of total 58 patients, out of which 30 had traumatic subconjunctival hemorrhage and 28 had spontaneous subconjunctival hemorrhage [4]. In spontaneous subconjunctival hemorrhage cohort, no other disease was found to be associated with this condition in 64.3% of the cases. Hypertension was associated with this condition in 14.3% of the cases. In traumatic subconjunctival hemorrhage, 67% of injuries were found to have happened at home [5].

Rapid rise in abdominal pressure against a closed glottis is termed as Valsalva’s manoeuvre. This rise induces a quick rise in intravenous pressure which causes the vessels inside or around the eyes to rupture because the veins above the heart do not have valves. Therefore, activities associated with strain like lifting heavy objects, passing stools during constipation, coughing etc. can lead to subconjunctival hemorrhage. Asphyxiation also causes rise in venous pressure and further rupture of subconjunctival vessels [6].

Prevention of subconjunctival hemorrhage is not possible unless there is a specific cause is identified for the bleeding (such as bleeding disorders or the use of blood thinning drugs). These drugs can be avoided to prevent the condition. Eyes should be rubbed gently when needed to avoid any trauma that might occur by rubbing it hard. To remove any foreign body from the eyes, it is advised to flush the eye gently with water or by using artificial tears. Wearing goggles can prevent any dust particles from entering into the eyes.

It is a protective coating of the eyeball and consists of several small blood vessels and nerves. Blood vessels in conjunctiva are normally invisible and can only be seen when there is inflammation in the eye. If the blood vessel beneath the thin cover breaks, the bleeding is trapped inside the transparent membrane which is usually considered harmless. The bright red color of the eye disappears in 1 to 2 weeks [1].

Deposition of outflowing blood from the blood vessels existing between the thin cover on the eye (conjunctiva) and the white part of the eye is called subconjunctival hemorrhage. The eye turns red but the blood does not exude from the eye. Simple rubbing of the eyes, elevation in blood pressure, vomiting or coughing or sneezing aggressively, using aspirin and warfarin like drugs, deficiency in vitamin K and vitamin C and blood clotting disorders are some of the causes for subconjunctival hemorrhage. Slight irritation in the eye, a sense of fullness and eye awareness in the eye are some of the common symptoms of subconjunctival hemorrhage. No other specific symptoms are seen and the condition is not a harmful one. Use of drugs like aspirin and warfarin are avoided till the bleeding stops and till the eye comes back to normal. Treatment for any bleeding disorder and high blood pressure is given if they are identified as the causes for subconjunctival hemorrhage. Artificial tears are used to provide soothing effect to the eye. 

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