Subconjunctival hemorrhage – Blood spot on the eye
You wake up one morning with a spot of bright red blood in the white part of your eye, without any pain. This is a subconjunctival hemorrhage. This alarming phenomenon, which can be triggered by high blood pressure or trauma, is perfectly benign. It should not be confused with other causes of red eye: conjunctivitis , keratitis , uveitis , scleritis , etc. It is also a very different condition from vitreous hemorrhages , which manifest as isolated, painless vision problems.
The symptoms
The main symptom of subconjunctival hemorrhages is the presence of a red spot in the white part of the eye.
This spot, composed of blood, is located between the conjunctiva and the sclera.
For the most important ones, they can sometimes "fill" the entire conjunctiva and completely mask the "white".
Subconjunctival hemorrhages are classically painless, although some discomfort may sometimes be present.
Evolution
Subconjunctival hemorrhage develops like a bruise on the skin.
It spreads gradually over 1 to 3 days until it covers all or part of the eye.
Then it disappears in 10 to 15 days, taking on different shades, first bright red then wine lees.
The size of the spot and the slowness of its absorption are in no way a criterion of severity!
Why consult a doctor?
Subconjunctival hemorrhages are perfectly benign and always heal without treatment.
However, it remains essential to seek urgent medical attention, especially if the bleeding is secondary to significant eye trauma.
During the examination, the ophthalmologist will then check for any damage to other structures, performing a fundus examination if necessary. Indeed, subconjunctival hemorrhages can sometimes mask genuine "wounds of the eyeball".
Apart from trauma, the ophthalmologist will simply confirm the diagnosis.
In this case, it will be necessary to have a search for high blood pressure done by the attending physician, which is found in approximately 10% to 20% of cases.
In cases of repeated subconjunctival hemorrhages, it will be necessary to investigate their cause and any possible underlying pathology: a hemostasis disorder or a thorough investigation of arterial hypertension by "holter blood pressure monitoring".
Causes
-
Most often, subconjunctival hemorrhage is spontaneous, with no cause found.
-
Subconjunctival hemorrhages can be secondary to trauma, including surgical trauma. In this case, they may appear immediately or with a delay.
-
Sometimes they occur after the removal of contact lenses.
-
They can also be the result of an underlying condition such as high blood pressure and be exacerbated by the use of anticoagulants or by hemostasis disorders (hemophilia).
The results
No further investigation is usually necessary in cases of spontaneous subconjunctival hemorrhage. However, in cases of repeated bleeding, monitoring for blood pressure spikes and coagulation disorders may be required. In such cases, the following tests should be performed:
A self-measurement blood pressure record – Taking blood pressure at rest 3 times a day for 3 to 5 days.
A blood test – To look for a drop in platelet count or a delay in coagulation (PT-PTA)
Subconjunctival vs. intraocular hemorrhages. What are the differences?
Subconjunctival hemorrhage (benign) should not be confused with intraocular hemorrhage, which are two completely distinct pathologies.
Intraocular hemorrhages are not visible externally (white eye) and primarily manifest as painless vision problems. They have numerous causes. Depending on the location, they may include:
Vitreous hemorrhage due to a retinal tear or detachment , manifesting as decreased vision and a "soot shower".
Macular hematoma , complicating AMD, which manifests as a loss of central vision.
These two entities can also be seen in cases of uncontrolled diabetes .
Treatment
Spontaneous subconjunctival hemorrhage does not require any treatment.
No eye drops have been proven effective in accelerating blood reabsorption.
Moisturizing eye drops (artificial tears) may be prescribed to reduce the feeling of discomfort.
Complications
-
Although alarming, spontaneous subconjunctival hemorrhage is never serious for the eye!
-
However, be careful in case of traumatic subconjunctival hemorrhage, as this may hide a wound of the eyeball that needs to be sutured.