ICD-10 Diagnosis Codes:
H11.31–Conjunctival hemorrhage, right eye
H11.32–Conjunctival hemorrhage, left eye
H11.33–Conjunctival hemorrhage, bilateral
Disorders Of The Conjunctiva
A subconjunctival hemorrhage is bleeding underneath the conjunctiva.
The conjunctiva is the clear tissue that covers the sclera and lines the inside of both eyelids. A subconjunctival hemorrhage is blood that is located between the conjunctiva and the underlying sclera.
- Vigorous eye rubbing
- Trauma to the eye or head
- Ocular or eyelid surgery
- Viral eye infection
Subconjunctival hemorrhages are mostly considered to be idiopathic since it is impractical to define the main causes. They can develop from either ocular or systemic conditions.
- Local trauma
- Acute inflammation of the conjunctiva
- Conjunctival tumors
- Ocular amyloidosis
- Contact lens usage
- Ocular surgery
- Ocular adnexal tumors
- Vascular disease
- Severe venous congestion
- Hematological dyscrasias
- Systemic trauma
- Acute febrile systemic diseases
- Carotid cavernous fistulas
Structural Damage to the Eye
Health complications are rare. In most cases, the underlying blood is absorbed within one to two weeks without treatment and without any structural damage to the eye.
Functional Damage to the Eye
Vision is usually not affected and any other functional damage that may occur is usually caused by some other ocular or systemic condition.
The main goal of the diagnostic evaluation in a patient with a subconjunctival hemorrhage is to accomplish the following:
- Determine the underlying associated systemic etiology of the conjunctival hemorrhage
- Prescribe a treatment program to treat the underlying condition
Patients usually come in because they notice the bleeding in the conjunctiva, but are otherwise asymptomatic in the early stages of the growth.
External Ocular Examination with Biomicroscopy
- Abnormal conjunctival vessel diameter
- Vessel tortuosity
- Distended vessels
- Damaged vessels
- Sacculated vessels
- Blood sludging
External Ocular Photography
- To document the progress or lack of progress of the conjunctival hemorrhage
- To document the delivery of medical treatment
- To document the response to treatment
Other Conjunctival Neoplasms With Secondary Hemorrhage
|Squamous Cell Carcinoma
Swelling (inflammation) or infection of the conjunctiva.
Red or purple lesion beneath the conjunctiva, usually elevated slightly.
Eyedrops may be used, such as artificial tears, to soothe any discomfort in the eye. Beyond that, the blood in the conjunctiva will absorb within about one to two weeks and no treatment will be necessary.
If minor ocular discomfort is associated with the hemorrhage, a mild topical steroid can be prescribed for short-term treatment.
1. Subconjunctival Hemorrhage (Broken Blood Vessel in Eye). Mayo Clinic. 22 Jan 2014. http://www.mayoclinic.org/diseases-conditions/subconjunctival-hemorrhage/basics/definition/con-20029242. Last accessed September 14, 2014.
2. Tarlan B. Kiratli H. Subconjunctival Hemorrhage: Risk Factors and Potential Indicators. National Library of Medicine. 12 Jan 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702240/. Last accessed September 14, 2014.
3. Subconjunctival Hemorrhage. The Wills Eye Manual (Fifth Edition). 2008. 112-113.
4. Sub-conjunctival Haemorrhage. The College of Optometrists. http://www.college- optometrists.org/download.cfm/docid/6267166e-8bdd-4a05-abf64b3dd4ad559a. Last accessed January 4, 2015.
- Subconjunctival hemorrhage occurs in approximately 2.9% of the general population
There are no specific distribution patterns with a subconjunctival hemorrhage, as it can affect anyone at any age.
- Advancing age
- Systemic hypertension
- Oral anticoagulant medication (aspirin, warfarin, etc.)
- Blood-clotting disorders