Bloodshot Eye: Understanding Subconjunctival Hemorrhage and Related Concerns

It was a regular day at the clinic when Mr. Thomas, a retired teacher, walked in looking slightly alarmed. His left eye appeared alarmingly red, almost as if a pool of blood had settled on the surface. “Doctor, I don’t know what happened. I woke up this morning, and my eye looked like this. It doesn’t hurt, but it looks terrifying!” he exclaimed.

Upon examining him, I quickly identified the issue: a subconjunctival hemorrhage (SCH). While dramatic in appearance, this condition is usually harmless and resolves on its own. However, the sight of a bloodshot eye can be unsettling, and understanding its causes and management is essential.

What Is a Bloodshot Eye?

A bloodshot eye occurs when blood collects on the surface of the eye, making it appear red. This can result from a variety of causes, including:

• Infections like conjunctivitis.
• Trauma from a minor injury, such as rubbing the eye too hard.
• Subconjunctival hemorrhage—a common and benign condition.

In Mr. Thomas’s case, the redness was due to SCH, which is essentially a small bleed underneath the conjunctiva.

What Is a Subconjunctival Hemorrhage (SCH)?

A subconjunctival hemorrhage is a painless and harmless bleed occurring between the conjunctiva (a thin, clear layer covering the white of the eye) and the sclera (the white part). It resembles a bright red patch on the eye and can be alarming but is rarely serious.

The conjunctiva is thin and delicate, housing tiny blood vessels that can rupture due to:

• Sudden increases in pressure from coughing, sneezing, or vomiting.
• Minor injuries to the eye.
• Whooping cough or other illnesses that strain the blood vessels.
• Use of blood-thinning medications (anticoagulants).

Image courtesy Wikipedia

Symptoms of a Subconjunctival Hemorrhage

Interestingly, most people with SCH are unaware of the condition until they look in the mirror. Unlike infections or more serious eye issues, SCH doesn’t usually cause:

• Pain.
• Vision impairment.
• Swelling or discharge.

The main symptom is the visible bright red patch on the white part of the eye. This patch may turn yellow or green before it fades completely.

What Causes SCH?

While SCH often occurs without any apparent reason, certain triggers include:

• Pressure changes: Activities like heavy lifting or forceful sneezing.
• Trauma: Even mild poking or rubbing of the eye.
• Medications: Blood thinners can make bleeding more likely.
• Health conditions: People with high blood pressure or bleeding disorders are more prone to SCH.

In Mr. Thomas’s case, he recalled sneezing forcefully the night before, which likely caused the bleed.

What Are the Risks of SCH?

While SCH is usually harmless, there are some risks to consider:

• It can sometimes indicate underlying bleeding disorders or high blood pressure.
• Repeated occurrences may warrant further investigation to rule out systemic health issues.

It’s crucial to consult a doctor if SCH follows a severe head injury or is accompanied by other symptoms like bruising elsewhere in the body.

Treatment for SCH

One of the most reassuring aspects of SCH is that it rarely requires treatment. The body naturally absorbs the blood over time, usually within two to three weeks. However, here’s what can help:

• Warm Compresses: These may improve comfort but won’t speed up healing.
• Avoidance of Blood Thinners: If safe to do so, your doctor may recommend pausing these medications temporarily.
• Treating the Underlying Cause: Managing high blood pressure or coughing can prevent recurrence.

I assured Mr. Thomas that his SCH would resolve on its own but recommended monitoring his blood pressure as a precaution.

Mr. Thomas left the clinic reassured and more informed about his condition. True to my advice, the redness in his eye faded over the next two weeks, leaving no lasting effects. While a bloodshot eye may be startling, understanding its causes and management can help alleviate unnecessary worry.

FAQs About Bloodshot Eyes and Subconjunctival Hemorrhage