context: The conjunctiva is the thin, moist, transparent membrane that covers the white part of the eye (called the sclera) and the inside of the eyelids. The conjunctiva is the outermost protective coating of the eyeball. The conjunctiva contains nerves and many small blood vessels. These blood vessels are usually barely visible but become larger and more visible if the eye is inflamed. These blood vessels are somewhat fragile, and their walls may break easily, resulting in a subconjunctival hemorrhage (bleeding under the conjunctiva). A subconjunctival hemorrhage appears as a bright red or dark red patch on the sclera. Most subconjunctival hemorrhages are spontaneous without an obvious cause. Often, a person may discover a subconjunctival hemorrhage on awakening and looking in the mirror. Most spontaneous subconjunctival hemorrhages are first noticed by another person seeing a red spot on your eye. The following can occasionally result in a spontaneous subconjunctival hemorrhage: Sneezing Coughing Straining/vomiting Straining on the toilet Eye rubbing Trauma (injury) High blood pressure Bleeding disorder (a medical disorder causing bleeding or inhibiting normal clotting) Subconjunctival hemorrhage can also be non-spontaneous and result from a severe eye infection or a trauma to the head or eye, or it can occur after eye or eyelid surgery. Most of the time, no symptoms are associated with a subconjunctival hemorrhage other than seeing blood over the white part of the eye. Very rarely people experience pain when the hemorrhage begins. When the bleeding first occurs, you may experience a sense of fullness in the eye or under the lid. As the hemorrhage resolves, some people may experience very mild irritation of the eye or merely a sense of awareness of the eye. The hemorrhage itself is an obvious, sharply outlined bright red area overlying the sclera. The entire white part of the eye may occasionally be covered by blood. In a spontaneous subconjunctival hemorrhage, no blood will exit from the eye. If you blot the eye with a tissue, there should be no blood on the tissue. The hemorrhage will appear larger within the first 24 hours after its onset and then will slowly decrease in size and may look yellowish as the blood is absorbed. Call your health care provider or eye care provider (optometrist or ophthalmologist) if the subconjunctival hemorrhage does not get better within two weeks or if you have had multiple subconjunctival hemorrhages. If you have a hemorrhage in both eyes at the same time or if the subconjunctival hemorrhage coincides with other symptoms of bleeding, including easy bruising, bleeding gums, or both, contact your health care provider or eye care provider. You may need to have blood tests. Go to your health care provider, eye care provider, or emergency department immediately if you have a subconjunctival hemorrhage and you have any of the following: Pain associated with the hemorrhage Changes in vision (for example, blurry vision, double vision, difficulty seeing) History of a bleeding disorder History of high blood pressure Injury from trauma to the eye Is there any sign of damage to the eye? Will I develop any scarring or permanent vision loss from this subconjunctival hemorrhage? What causes a subconjunctival hemorrhage? How can I prevent a subconjunctival hemorrhage? Your health care provider or eye care provider will take a concise history of the events prior to the subconjunctival hemorrhage and perform an examination. Your blood pressure may also be checked. If you've been evaluated by your primary health care provider initially, you may be referred to an eye care specialist. If trauma was the cause, a more thorough examination using a slit lamp (a special microscope for examining the eye) will usually be performed. Usually, no treatment is needed. Over-the-counter artificial tears can be applied to the eye if mild irritation is present. Unless otherwise directed by your health care provider, you should avoid the use of aspirin, ibuprofen, naproxyn, or other nonsteroidal anti-inflammatory medications as these can increased bleeding. Usually, no treatment is required. Your health care provider or eye care provider may prescribe artificial tears to ease any irritation that may be present. If the injury is related to trauma, your health care provider or eye care provider may need to examine your eye to rule out the possibility of damage to other parts of the eye. This condition clears by itself within one to two weeks. Usually, recovery is complete, without any long-term problems, similar to a mild bruise under the skin. Like a bruise, a subconjunctival hemorrhage changes colors (often red to orange to yellow) as it heals. A skin bruise changes to various shades of green, black and blue as it heals, because the blood is being seen though skin. Because the conjunctiva is transparent, a subconjunctival hemorrhage never has these color characteristics. American Academy of Ophthalmology 655 Beach Street Box 7424 San Francisco, CA 94120 (415) 561-8500 Media file 1: Subconjunctival hemorrhage. Photograph courtesy of Lawrence B. Stack, MD, Vanderbilt University. Author: Roger K George, MD, Director of Uveitis Service, Madigan Army Medical Center; Clinical Assistant Professor, Department of Ophthalmology, Oregon Health Sciences University. Coauthor(s): David Asrael, MD, Staff Physician, Department of Emergency Medicine, Temple University; Jacob W Ufberg, MD, Assistant Professor, Department of Emergency Medicine, Temple University School of Medicine. Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, Pharm D, Ph D, Senior Pharmacy Editor, e Medicine; Robert H Graham, MD, Ophthalmologist, Robert H Graham, MD, PC; Affiliated With Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona and Carl T Hayden VA Medical Center, Phoenix, Arizona.