Montes Eye


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SUBCONJUNCTIVAL HEMORRHAGE



subconjunctival hemorrhage





Jorge A . Montes, MD, FACS



A subconjunctival hemorrhage is very visually displeasing and can cause alarm when one presents.


Although they have many causes, they tend to act the same regardless of cause.


SYMPTOMS

Most subconjunctival hemorrhages are pain-free. People tend to notice them when looking at their reflection, most commonly upon awakening. Sometimes, if the bleed is substantial, they can produce foreign body symptoms.


ANATOMY AND PHYSIOLOGY

The wall of the eye, the Sclera, has two layers of skin overlying it with a potential space in between each other. Although these two layers of skin are very vascular, the eye's white appearance comes from the Sclera, not the skin. Each of the two skin layers has its names. The outermost layer is the conjunctiva, while the layer beneath that is called Tenons. These layers are physiologically one layer but can separate from each other in certain situations i.e., trauma, bleeds, surgery, and pterygia.

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skin of the eye aka conjunctiva



When a bleed occurs, one of the blood vessels under the conjunctiva ruptures; hence the name "Sub" is beneath, and "Hemorrhage" is to bleed. The red color of the blood contrasts with the white of the sclera wall. Note that this is a superficial bleed of the eye and not a bleed inside the eye that can be commonly seen, for instance, in diabetic retinopathy. At times, the pressure from the artery can cause the potential space between these layers to separate like a water-filled cyst.​



normal vs subconjunctival bleeds in different phases



​CAUSES

This condition is multifactorial. A good medical history is needed to determine the cause and hence, the treatment and prognosis. The most common causes are:

  • • Dry Eyes
  • • Trauma
  • • Eye Rubbing
  • • High Blood Pressure


TREATMENT

A subconjunctival hemorrhage treatment depends on its cause and whether or not it has caused discomfort. There is rarely any visual disturbance, and most people are primarily concerned with the bleed's cosmetic appearance.


Non-preserved lubricating eye drops can are best if discomfort presents.


PROGNOSIS

The prognosis is usually excellent. The blood will slowly fade away as with any bruise. Although sometimes alarming, the blood can migrate in the potential space that it is in and accumulate in the inferior portion of the eye - this is normal and happens due to gravity.


Control of the presenting risk factors will prevent recurrences. Subconjunctival hemorrhages are not damaging to the eye as much as they are visually displeasing.


If they don't resolve or if the appearance concerns you, have a visit with your ophthalmologist.


Also read What is a Subconjunctival Hemorrhage? by the © American Academy of Ophthalmology





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