FFinalistSouthampton · 2027
Ophthalmology
AKT · Ophthalmology/Lids & surface

Subconjunctival haemorrhage

Rupture of a small subconjunctival vessel (spontaneous or Valsalva/anticoagulant-related)

Overview

A flat, painless, well-demarcated patch of blood under the conjunctiva from a ruptured vessel. Benign and self-limiting; the role of the clinician is to reassure and to check for the few meaningful associations (hypertension, anticoagulation, trauma; bilateral/recurrent → bleeding tendency).

Recognise

  • Painless, sudden, bright-red flat patch with normal vision and a white cornea
  • No discharge, no photophobia; often noticed by someone else or in the mirror
  • Triggers: Valsalva (cough/sneeze/straining), trauma, anticoagulants, hypertension

Red flags

  • Following trauma with no posterior border visible, or with reduced vision/proptosis → exclude globe rupture/orbital injury (refer)
  • Recurrent/spontaneous bilateral haemorrhages → check clotting/platelets

Differentials & how to tell them apart

Conjunctivitisdiffuse injection with discharge — not a discrete blood patch
Traumatic hyphaema / globe ruptureblood inside the eye (anterior chamber) with reduced vision after trauma — an emergency
Conjunctival/Kaposi lesiona raised vascular lesion rather than a flat resolving bruise
Subconjunctival haemorrhage — flat, well-demarcated blood under the conjunctiva

Subconjunctival haemorrhage — flat, well-demarcated blood under the conjunctiva

James Heilman, MD / CC BY-SA 3.0 — Wikimedia Commons

Investigations

Clinical. Check BP; check INR if on warfarin; clotting screen only if recurrent/bilateral or other bleeding.

Management

Reassurance — resolves in 1–2 weeks; treat hypertension/anticoagulation if relevant

  1. 1Reassure: clears spontaneously over 1–2 weeks (changes colour like a bruise). Measure BP and treat if raised; check INR if on warfarin. Cold compress if uncomfortable.Gate: Refer if it followed significant trauma (exclude globe rupture / no visible posterior margin), or if there is reduced vision, pain or photophobia (then it is not a simple SCH)
  2. 2Recurrent/spontaneous → investigate for a bleeding diathesis.
None (reassurance) — lubricants/cold compress only if irritation

Key points

Painless, vision normal, white-and-quiet cornea, blood is flat and superficial = benign. The trap is the trauma case hiding a ruptured globe.

Monitor & prognosis

Self-resolves; no follow-up unless recurrent.

Excellent.

Source: NICE CKS Red eye