Understanding Subconjunctival Hemorrhage
The conjunctiva is the thin, clear tissue that covers the white part of your eye and lines the inside of your eyelids. Underneath this tissue, there are many tiny blood vessels. When one of these small vessels breaks, blood leaks into the space between the conjunctiva and the white of the eye, called the sclera. This trapped blood creates a bright red patch on the surface of your eye.
The red spot may cover a small area or spread across much of the white of your eye. Even though it can look serious, the blood is contained in a thin layer and does not affect the inside of your eye. It does not reach the colored part of your eye or the pupil. Think of it like a bruise under the skin, except it happens under the clear surface of your eye.
Many everyday actions can cause a small blood vessel in the eye to break. Sneezing, coughing, and straining during a bowel movement can all create a brief rise in pressure that is enough to rupture a tiny vessel. Heavy lifting, bending over, or vomiting can have the same effect. Rubbing your eyes forcefully is another frequent trigger.
Minor injuries to the eye area can also cause a subconjunctival hemorrhage. Bumping your eye, getting poked by a finger, or having a small object brush against the surface of your eye may lead to a broken vessel. Wearing contact lenses that are not fitted properly can contribute as well. According to the American Academy of Ophthalmology in 2023, more than 2.4 million eye injuries occur in the United States each year, and subconjunctival hemorrhages are among the more common results of minor eye trauma.
While a subconjunctival hemorrhage can happen to anyone at any age, certain factors can make it more likely. People who take blood-thinning medications, including aspirin and prescription blood thinners, may experience broken blood vessels more often because their blood does not clot as quickly. High blood pressure is another factor, because elevated pressure puts more stress on the walls of small blood vessels.
People with diabetes may also have more fragile blood vessels throughout the body, including in the eyes. Older adults tend to get subconjunctival hemorrhages more often as well, because blood vessels can become thinner with age. Conditions that affect blood clotting, such as bleeding disorders, can also make these hemorrhages more frequent.
In most cases, a subconjunctival hemorrhage does not affect your vision. The bleeding happens on the outer surface of your eye, not inside the eye where the structures that control vision are located. You may feel a mild sense of fullness or slight scratchiness, but the red spot itself should not cause pain or blur your sight. Your body will gradually absorb the blood over time, much like the way a bruise fades from the skin.
Evaluation and Treatment
While most subconjunctival hemorrhages go away on their own, there are situations where you should schedule a visit. If the red spot appeared after a direct blow or significant injury to the eye, it is important to have an exam to rule out deeper damage. A forceful impact can sometimes cause problems inside the eye that are not visible from the outside.
You should also reach out if you notice changes in your vision along with the red spot. Blurred vision, double vision, or seeing floaters or flashes of light could point to a more serious issue. Pain in the eye is another reason to seek care, since a typical subconjunctival hemorrhage should not cause significant discomfort. If you get these hemorrhages frequently, meaning several times within a few months, your provider may want to look into possible underlying causes such as uncontrolled blood pressure or clotting problems.
When you visit Washington Eye Institute for a subconjunctival hemorrhage, your provider will start by asking about your symptoms and recent activities. They will want to know when you first noticed the red spot, whether anything specific happened before it appeared, and whether you are experiencing any pain or vision changes.
Your provider will examine your eye using a slit lamp, which is a special microscope with a bright light that allows them to see the front of your eye in fine detail. This painless exam helps confirm that the blood is under the conjunctiva and not inside the eye. They may also check your eye pressure using a comfortable test called tonometry, and in some cases place fluorescein dye on the surface of your eye to check for scratches on the cornea.
Most subconjunctival hemorrhages do not require medical treatment. The blood will gradually be absorbed by your body over one to two weeks. At first, the bright red color may look intense, but as healing progresses, the spot often changes to shades of orange, yellow, and brown before fading completely. This color change is a normal part of the healing process.
If the surface of your eye feels dry or scratchy while the hemorrhage is healing, lubricating eye drops, often called artificial tears, can provide comfort. These drops add moisture to the eye surface and can reduce any gritty feeling. You can find them at most pharmacies without a prescription. Avoid rubbing your eyes while the hemorrhage is healing, since rubbing could slow the process or cause further irritation.
If you experience subconjunctival hemorrhages multiple times, your provider may want to look deeper into the cause. They may refer you for blood work to check your clotting factors and platelet levels. According to the National Eye Institute in 2022, people with uncontrolled high blood pressure are at greater risk for a range of eye conditions, including hemorrhages on the surface of the eye. Managing the underlying cause is often the most effective way to reduce how often these episodes occur.
What to Expect During Your Visit
When you call to schedule your visit, our staff will ask about your symptoms so they can help you get the right type of appointment. It helps to have some information ready, including when you first noticed the red spot and whether you had any coughing, sneezing, or straining before it appeared.
Make a list of all medications you are taking, including over-the-counter pain relievers, supplements, and prescription blood thinners. Also note any health conditions you have, such as high blood pressure, diabetes, or bleeding disorders. If you wear contact lenses, switch to your glasses before the visit, as you may be asked to leave your contacts out during the exam.
When you arrive, a member of our team will check you in and may take initial measurements, including your vision and eye pressure. You will then meet with your provider, who will review your symptoms and health history before examining your eye.
The slit lamp exam is the main part of the evaluation. You will rest your chin on a small support while your provider looks through the microscope at the front of your eye. The bright light may feel slightly uncomfortable, but the exam is painless and usually takes only a few minutes. Your provider will check the size and location of the hemorrhage, look for signs of deeper injury, and evaluate your eye surface.
After your appointment, your provider may give you instructions for using lubricating eye drops if your eye feels dry or irritated. They will let you know whether you need a follow-up visit. In most cases, no follow-up is needed because the hemorrhage will resolve on its own. However, if your provider ordered blood work or wants to monitor your blood pressure, they may ask you to return.
As the hemorrhage heals, the red color will gradually shift and fade over one to two weeks. Some larger hemorrhages may take a bit longer to clear. During this time, you can go about your normal daily activities, including reading, using screens, and spending time outdoors.
Your Care Journey at Washington Eye Institute
If you notice a red spot on the white of your eye, reaching out to our team is a simple first step. You can call any of our locations in Greenbelt, Rockville, or Cumberland, Maryland, and our staff will help you determine whether you need an evaluation. For situations involving pain, vision changes, or eye trauma, we will work to see you as soon as possible. Our fellowship-trained specialists have extensive experience evaluating and managing subconjunctival hemorrhages, along with the full range of eye conditions.
While it is not possible to prevent every subconjunctival hemorrhage, there are steps you can take to lower the chances. Avoiding forceful eye rubbing is one of the simplest things you can do. If your eyes feel itchy or dry, try using lubricating drops instead of rubbing. Managing your blood pressure through regular check-ups, a balanced diet, and physical activity can also reduce the strain on small blood vessels throughout your body.
If you wear contact lenses, follow the recommended wearing schedule and cleaning instructions. Replace your lenses on time and avoid sleeping in them unless your provider has specifically said it is safe. Wearing protective eyewear during sports or activities where your eyes could be bumped is another practical way to reduce the risk of eye injuries. Regular eye exams are an important part of maintaining your overall eye health, and our team at Washington Eye Institute is here to help you protect your vision.
Questions and Answers
Most subconjunctival hemorrhages clear up on their own within one to two weeks. The red spot will gradually change color as your body absorbs the blood, shifting from bright red to orange, yellow, or brown before disappearing. Larger hemorrhages may take a little longer, sometimes up to three weeks. Lubricating eye drops can help if the area feels dry or scratchy during healing.
In most cases, a subconjunctival hemorrhage does not require a trip to the emergency room. However, you should seek prompt care if the red spot appeared after a significant injury to the eye, if you are experiencing eye pain, or if you notice changes in your vision such as blurriness or flashes of light. If none of these symptoms are present, scheduling a visit with your eye care provider within a few days is usually appropriate.
A single, occasional subconjunctival hemorrhage is usually not a sign of a serious condition. However, if they happen repeatedly, it may indicate an underlying issue such as uncontrolled high blood pressure, a blood clotting disorder, or a side effect of blood-thinning medications. If you get red spots on your eyes frequently or bruise easily in other areas, it is worth discussing with your provider.
It is generally a good idea to avoid wearing contact lenses while you have a subconjunctival hemorrhage, especially if your eye feels irritated or dry. Contact lenses can add friction to the surface of your eye and may slow healing. Switch to your glasses until the red spot has faded and your eye feels comfortable again. Ask your provider when it is safe to resume wearing your contacts.
A subconjunctival hemorrhage does not leave a scar on your eye. Once your body absorbs the trapped blood, the white of your eye will return to its normal appearance. There is no lasting discoloration or structural change, and the typical single episode heals completely without any visible trace.
There is no way to make the blood absorb faster, but you can keep your eye comfortable while it heals. Using lubricating eye drops a few times a day can help if the surface of your eye feels dry or gritty. Avoid rubbing your eyes, even if they feel itchy. Applying a cool, damp cloth over your closed eyes for a few minutes can also feel soothing. Stay hydrated and get enough rest, as your body heals more efficiently when it is well rested.