chronic

Subconjunctival hemorrhage

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

AAO Patient Advice Guidelines · No labelled dose - a lubricant appliance, not a licensed medicine; instilled as often as comfort needs

Verified against2 documents

No labelled dose - a lubricant appliance, not a licensed medicine; instilled as often as comfort needs
Subconjunctival Hemorrhage - disease-level clinical article (subconjunctival-haemorrhage-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

Many patients only discover the hemorrhage by chance, in a mirror or when someone else points it out [bleeding]
Coughing, sneezing, vomiting, or heavy lifting are potential triggers worth asking about [cough · sneezing · vomiting]
Vision loss, discharge, light sensitivity, a foreign-body feeling, or headache point toward a different diagnosis [foreign body · headache · photophobia]
The bleed itself is painless and vision stays normal despite the visible blood

Signs — what you find (5)

Traumatic bleeds tend to be more localized, while spontaneous bleeds in older adults tend to be more diffuse, most often over the lower-outer conjunctiva [bleeding]
A straightforward bleed should not come with chemosis, bulging of the eye, pus, or limited eye movement [pus]
A raised, blister-like hemorrhage suggests scleral rupture letting intraocular blood escape into the subconjunctival space [bleeding · blisters]
True conjunctival hemorrhage gives a continuous red sheet across the sclera, distinct from the halo-like ciliary flush of intraocular inflammation [bleeding]
Unlike conjunctivitis, this condition causes little pain and produces a discrete, confluent patch of blood rather than diffuse redness, and it is usually one-sided

Tests (8)

Diagnosis is mainly clinical, with lab or imaging rarely needed for an isolated one-sided event without other findings
Exam must confirm normal vision and normal eye pressure, without pain or light sensitivity
Recurrence, involvement of both eyes, bruising elsewhere, or anticoagulant use are red flags calling for further work-up
Blood pressure should be checked in every spontaneous or recurrent case, given the tie to uncontrolled hypertension
Basic coagulation labs - complete blood count, PT, aPTT, and INR - can uncover a clotting problem or excess anticoagulation
Slit-lamp exam checks for a retained foreign body and subtle conjunctival problems like conjunctivochalasis or pinguecula
Reduced vision or an afferent pupil defect should prompt a dilated fundus exam and OCT to rule out retinal or vitreous bleeding
In children, work-up stays limited unless abuse, systemic disease, or both-eye involvement raise concern

If not this — what else fits (11)

Episcleritis causes localized redness with mild irritation but lacks the sharp, well-defined patch of this condition
Scleritis is often bilateral, tied to systemic autoimmune disease, and shows a violet color with marked tenderness to touch
Globe rupture or retrobulbar hematoma must be ruled out after orbital trauma and can show bulging of the eye, chemosis, reduced vision, or a tear-drop pupil
Grittiness or a foreign-body sensation should not occur in an uncomplicated bleed and points elsewhere
Conjunctival hemangiomas or arteriovenous malformations can mimic the condition through localized vascular congestion, especially if thrombosed or irritated
Kaposi sarcoma-related conjunctival lesions tend to outlast a simple hemorrhage and look nodular or raised on slit-lamp exam
Hyphema shows a crimson fluid level in the anterior chamber and may bring discomfort, light sensitivity, and raised eye pressure
Vitreous hemorrhage instead causes floaters, vision loss, and a hazy view of the fundus, often from diabetic retinopathy, trauma, or a retinal tear
In children, abuse-related bleeds are often bilateral or paired with retinal hemorrhages and other trauma signs such as bruising or fractures
A recurring bleed in a child calls for a bleeding-disorder work-up, particularly with petechiae, nosebleeds, or mucosal bleeding alongside it
Infectious conjunctivitis produces a red eye with pus, itching, or a recent cold, whereas this condition is symptomless with just bright red staining and no discharge

SourceStatPearls "Subconjunctival Hemorrhage" - disease-level clinical article

Presentation findings are traced to the source above.

SODIUM HYALURONATE

1st line

Formeye

Adult dose and duration

Instill 0.1-0.2% lubricating eye drops 1 drop 4 times daily as needed for mild ocular irritation or dryness x 1-2 weeks

Paediatric dose

Child: 1 drop 3-4 times daily as needed for symptom comfort

Dose source

No labelled dose - a lubricant appliance, not a licensed medicine; instilled as often as comfort needs

Why

Benign self-limiting condition; treatment is purely ocular lubrication and patient reassurance

Cautions

Reassure patient that hemorrhage resolves spontaneously over 1-3 weeks without visual sequelae.
Check systemic blood pressure and ask about anticoagulant therapy or head/eye trauma.
Refer to ophthalmology if accompanied by eye pain, vision changes, photophobia, or history of blunt ocular trauma.
Sodium hyaluronate drops are sold as an appliance rather than a licensed medicine, so no regulator has set a dose for them. Use them as often as the eye needs and judge by comfort.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
HYALUGRAND 0.2% EYE DROPS 10 ML	DELTA GRAND PHARMA	41.00 EGP
HYALOPTIC 0.2% EYE DROPS 10 ML	PHARCO	48.00 EGP
HYFRESH 0.2% EYE DROPS 10 ML	JAMJOOM PHARMACEUTICALS	75.00 EGP
HYABAK 0.15% EYE DROPS 10 ML	LABORATOIRES THEA > AMICO	69.00 EGP
XILOIAL MONO EYE DROPS 20 RE-CLOSABLE VIALS * 0.5 ML	FARMIGEA > HABIB SCIENTIFIC OFFICE	265.00 EGP
VISMED MULTI 0.18% EYE DROPS 10 ML	TRB CHEMEDICA SA > RHEUMA	335.00 EGP
VISMED 0.3% EYE GEL 20 X 0.45 ML SDU	TRB CHEMEDICA SA > RHEUMA	390.00 EGP
VISMED MULTI 0.3% EYE GEL 10 ML	TRB CHEMEDICA SA > RHEUMA	390.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Subconjunctival Hemorrhage - disease-level clinical article (subconjunctival-haemorrhage-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - Pain, photophobia, impaired vision, discharge, or recurrent bilateral haemorrhage separate a more serious ocular or systemic problem from an uncomplicated subconjunctival haemorrhage. Systemic bruising, gum bleeding, or a personal or family history of coagulopathy may need laboratory evaluation and haematology referral.
RED FLAG - Emergency ophthalmology referral is indicated when the haemorrhage follows trauma with suspected intraocular or retinal injury. Recurrence, bilateral involvement, systemic bruising, or anticoagulant therapy warrant further evaluation, and blood pressure measurement is essential in spontaneous or recurrent haemorrhage.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.