Sub-conjunctival Haemorrhage or Ecchymosis, a benign condition, is a common cause of conjunctival redness. It is characterised by painless acute redness due to bleeding underneath conjunctiva, in the absence of discharge or inflammation.The major risk factors are trauma or contact lens wearing in young patients, but in elderly, systemic vascular diseases such as hypertension, diabetes, and arteriosclerosis are common.
Recurrent or persistent sub-conjunctival haemorrhage needs to be investigated for systemic hypertension, ocular or systemic malignancies, bleeding disorders, and any side effects of drugs.
Sub-conjunctival haemorrhage may vary in extent from small petechial haemorrhage to an extensive one, spreading under whole of bulbar conjunctiva. Generally, sub-conjunctival haemorrhage is most often seen in temporal and inferior parts of conjunctiva. Trauma causes localised haemorrhage at the site of injury.
The vision is usually unaffected by the sub-conjunctival haemorrhage. An extensive sub-conjunctival haemorrhage may track into the eyelids. Normally, haemorrhage resolves on its own in one to two weeks. Two or three narrowly spaced episodes may also occur.
Sub-conjunctival haemorrhage is usually asymptomatic and present as a flat sheet of homogeneous red colour having well- defined limits. The collection of bright smooth blood is confined to a sector of the bulbar conjunctiva, and is sharply demarcated at the limbus.
The posterior limit of haemorrhage is visible in sub-conjunctival haemorrhage due to local trauma to the eyeball. The posterior limit is not visible in haemorrhages due to orbital injury. A large haemorrhage may track into the eyelids.
During absorption of haemorrhage, the colour changes from bright red to orange and then yellow. Some pigmentation may be left behind in severe cases of haemorrhage.
Sometimes, there may be momentary sharp pain or a snapping or popping sensation.
Vision is usually unaffected, but substantially elevated haemorrhage with Dellen formation on cornea may affect vision.
Sub-conjunctival haemorrhage is a very common condition.
Causes of sub-conjunctival haemorrhage includes
Diagnosis of sub-conjunctival haemorrhage is mainly clinical.
There is acute and painless redness of bleeding beneath conjunctiva in the absence of discharge or inflammation. It may produce dot haemorrhages to extensive areas of bleeding.
Sub-conjunctival haemorrhage is most often seen in temporal and inferior parts of conjunctiva, but trauma causes localised haemorrhage.
Histologically, sub-conjunctival haemorrhage lies between conjunctiva and episclera, and the blood elements are found in the substantia propria of the conjunctiva when a sub-conjunctival vessel breaks.
There is no approved therapy to accelerate the resolution of haemorrhage. It requires only reassurance to patient that haemorrhage will disappear in about two to three weeks, with blood turning from red to yellow before absorption.
Failure to resolve haemorrhage in persistent or recurrent cases require detailed examination. No treatment is required unless it is associated with serious conditions.