Subconjunctival Hemorrhage

🩸 Subconjunctival Hemorrhage (SCH)

🔍 Definition

A subconjunctival hemorrhage is bleeding beneath the conjunctiva, the clear tissue covering the white part of the eye (sclera). It appears as a bright red patch on the eye but is typically painless and benign.

---

👀 Clinical Features

Feature	Description
Appearance	Bright red, sharply defined patch on sclera
Laterality	Usually unilateral
Pain	Absent — eye feels normal
Vision	Unaffected
Other symptoms	No discharge, photophobia, or itching
Resolution	Clears up spontaneously in 1–2 weeks
Color change	Fades from red → brown/yellow → normal (like a bruise)

---

🧬 Etiology (Causes)

🔹 Spontaneous (most common)

• Sudden increase in venous pressure:

  • Coughing, sneezing

  • Vomiting

  • Heavy lifting

  • Constipation

• Often in hypertensive patients

• Elderly (fragile blood vessels)

🔹 Traumatic

• Rubbing the eye

• Blunt trauma

• Contact lens injury

• Eye surgery

🔹 Secondary to systemic issues

• Hypertension

• Bleeding disorders (e.g., thrombocytopenia, leukemia)

• Anticoagulant use (e.g., aspirin, warfarin)

• Diabetes mellitus

• Severe infections (e.g., pertussis, dengue, etc.)

🔹 Post-surgical

• After ocular procedures like strabismus or pterygium surgery

---

🩺 Diagnosis

🔍 Clinical

• Diagnosis is usually clinical

• History is key to rule out trauma, anticoagulant use, or bleeding disorder

🧪 Investigations (if recurrent or in systemic disease)

• Blood pressure check

• CBC, PT, aPTT – if bleeding tendency suspected

• Blood glucose – for diabetes

• Review medications

---

💊 Management

Approach	Description
Reassurance	Most important – it resolves on its own
Lubricating drops	For comfort, if there is mild irritation
Avoid rubbing eye	Prevent re-bleeding
Control systemic issues	e.g., hypertension, anticoagulation levels
No need for antibiotics or steroids unless infection is present

⏳ Time to resolution: Usually clears up in 7–14 days

---

⚠️ When to Investigate Further

• Recurrent episodes

• Bleeding elsewhere (e.g., gums, nosebleeds)

• Associated trauma

• On anticoagulants or antiplatelet drugs

• Suspected systemic disease (HTN, bleeding disorder)

---

📋 Quick Summary Table

Feature	Subconjunctival Hemorrhage
Cause	Spontaneous, trauma, systemic disease
Appearance	Bright red patch on white of eye
Pain / Vision	No pain, no vision loss
Diagnosis	Clinical
Treatment	Reassurance, lubricants if needed
Resolution time	1–2 weeks
Investigate if	Recurrent, traumatic, bleeding history

---

🧠 Mnemonic – “S C H = Sudden, Clear history, Harmless”

• S – Sudden red patch

• C – Clear cause (strain, trauma, HTN)

• H – Harmless and self-limiting