A subconjunctival hemorrhage or hematoma (SCH) may be a minor non–vision-threatening finding, or it could be associated with a major vision-threatening injury. SCH may occur with trivial events such as a cough, sneeze, Valsalva maneuver, or minor blunt trauma. The blood is usually bright red and sharply circumscribed and appears flat. It is limited to the bulbar conjunctiva and stops abruptly at the limbus. This appearance is important to differentiate from bloody chemosis, which can occur with scleral rupture or nontraumatic conditions. Uncomplicated SCH does not usually cause pain or diminution in visual acuity.
Subconjunctival Hemorrhage. Subconjunctival hemorrhage from blunt trauma. The flat appearance of the hemorrhage suggests its benign nature. (Photo contributor: James K. Palma, MD, MPH.)
Subconjunctival Hemorrhage. Subconjunctival hemorrhage that completely surrounds the eye but stops abruptly at the limbus in a patient with blunt trauma. (Used with permission from Brice Critser, CRA, The University of Iowa and EyeRounds.org.)
Management and Disposition
No treatment is required. Instruct the patient to expect the blood to resorb within 2 to 3 weeks.
Elevated, dense, circumferential SCH should prompt evaluation for bleeding diathesis or globe rupture.
SCH involving the extreme lateral globe after blunt trauma is very suspicious for zygomatic arch fracture.
Evaluate patients with nontraumatic bloody chemosis for an underlying metabolic (coagulopathy) or structural (cavernous sinus thrombosis) disorder.
Traumatic Bloody Chemosis. This anticoagulated patient presented after relatively minor trauma with normal visual acuity. He was able to close his eye and required only supportive care. (Photo contributor: R. Jason Thurman, MD.)
Traumatic Bloody Chemosis. Globe integrity should be assessed with CT and exam by an ophthalmologist. (Photo contributor: Alan B. Storrow, MD.)