# Subconjunctival hemorrhage - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAO Patient Advice Guidelines · No labelled dose - a lubricant appliance, not a licensed medicine; instilled as often as comfort needs - Verified date: 2026-08 ## Verified against - 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) ## Treatment metadata - Sodium hyaluronate — eye - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text SUBCONJUNCTIVAL HEMORRHAGE Sources: AAO Patient Advice Guidelines · No labelled dose - a lubricant appliance, not a licensed medicine; instilled as often as comfort needs Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Subconjunctival Hemorrhage" - disease-level clinical article Status traced to the source above 1. SODIUM HYALURONATE [1st line] Adult 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 Peds Child: 1 drop 3-4 times daily as needed for symptom comfort 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 Caution 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. Egypt HYALUGRAND 0.2% EYE DROPS 10 ML DELTA GRAND P... 41.00 EGP HYALOPTIC 0.2% EYE DROPS 10 ML PHARCO 48.00 EGP HYFRESH 0.2% EYE DROPS 10 ML JAMJOOM PHARM... 75.00 EGP HYABAK 0.15% EYE DROPS 10 ML LABORATOIRES ... 69.00 EGP XILOIAL MONO EYE DROPS 20 RE-CLOSABLE VIALS * 0.5 ML FARMIGEA > HABIB SC... 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... 390.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)