Sub-conjunctival haemorrhage

A sub-conjunctival haemorrhage is caused by a bleeding blood vessel under the conjunctiva. Patients will often present after being told they have a red eye and may not have noticed any symptoms. They usually have no cause but are more common after coughing or vomiting excessively. Can also be caused by mild trauma.

Symptoms

  • Patients may describe a mild popping sensation in the eye prior to observing the redness
  • May describe a mild FB sensation or an eye ache
  • Usually symptom free
  • Ask/review use of any NSAIDs or anticoagulants
  • Any history of coughing, straining, trauma or vomiting 

Signs

  • A flat, bright red haemorrhage in the conjunctiva 

Eye examination

  • Check blood pressure
  • Observe lids and conjunctiva with white light
  • Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
  • Observe for corneal staining preferably using a blue light 

Treatment

  • Give patient sub-conjunctival haemorrhage information leaflet
  • If no history of trauma, no treatment is required. Reassure patient that the haemorrhage will resolve over the course of about a week or two  
  • If trauma is the cause, consider referral to an ophthalmologist to ensure no underlying scleral damage or other injury
  • If subconjunctival haemorrhages are recurrent further investigations may be required to exclude any clotting disorders; however in most cases no underlying serious cause will be found