Subconjunctival Hemorrhage (Burst Blood Vessel in the Eye)

What a subconjunctival hemorrhage is

The conjunctiva is a thin, transparent membrane that covers the white of the eye (sclera) and lines the eyelids. It contains many small, fragile blood vessels. When one breaks, blood leaks into the space between the conjunctiva and sclera. Because the conjunctiva cannot absorb the blood quickly, the blood spreads out under it like a bruise under clear plastic.

The blood stays on the surface of the eye. It does not get inside the eye and does not affect the cornea, lens or retina, which is why vision is normal.

What it looks like and feels like

• a flat, bright red or dark red patch on the white of the eye, from a small spot to the whole visible white
• sharp, well-defined edges
• no discharge
• usually no pain; at most a mild scratchy feeling or awareness of the eye
• often noticed in the mirror or by someone else, sometimes on waking

The patch can seem to spread for the first day or two as blood settles, then gradually changes color from red to orange, yellow and green before disappearing.

Common causes

Sudden pressure rises

Anything that briefly raises pressure in the veins of the head can break a small vessel:

• violent coughing or sneezing
• vomiting
• straining on the toilet, heavy lifting
• childbirth, both for the mother and sometimes the newborn
• intense exercise

Local irritation or minor injury

• rubbing the eyes
• inserting or removing contact lenses
• minor scratches or a small foreign body
• after eye surgery, including LASIK and cataract surgery, or eye injections

Medicines and medical conditions

• Blood thinners: aspirin, clopidogrel, warfarin and newer anticoagulants such as apixaban and rivaroxaban
• High blood pressure: more common in people with hypertension, especially if uncontrolled
• Diabetes and aging, which make vessels more fragile
• Bleeding or clotting disorders, including low platelets
• Viral conjunctivitis caused by certain adenoviruses or enteroviruses, which can cause small hemorrhages along with a sticky red eye

Often no cause is found, and the bleed simply appears overnight.

Subconjunctival hemorrhage vs other red eyes

When to worry

A subconjunctival hemorrhage is harmless in most people, but get it checked when:

• It follows an injury. A large, swollen hemorrhage after trauma can hide a serious injury, including a ruptured eyeball, which needs an emergency eye exam. See eye trauma.
• There is pain, light sensitivity or reduced vision. These suggest a different problem.
• It keeps happening. Repeated bleeds should prompt a check of blood pressure, medicines and a blood count and clotting tests.
• You are on warfarin. Your INR may need checking.
• There is other unusual bleeding or bruising.

A doctor examines the eye, may use a slit lamp microscope, and checks your blood pressure. Further tests are only needed for recurrent bleeds or other concerns.

Treatment and home care

The blood absorbs on its own; no medicine speeds this up.

• Artificial tears (lubricating drops) can ease scratchiness.
• Avoid rubbing the eye.
• Pain relief: if you need it, acetaminophen (paracetamol) is preferred over aspirin or ibuprofen, which can increase bleeding. Follow the label dose.
• Contact lenses: it is usually fine to continue if comfortable, but take a break if the eye feels irritated.
• Do not stop prescribed blood thinners without talking to your doctor.
• Cold compresses in the first day may give comfort but do not clear the blood faster.

How long it takes to heal

People taking blood thinners may take longer. The patch may look yellow or green at the edges as it fades; this is normal.

Prevention

• Control blood pressure and diabetes.
• Treat chronic coughs and constipation to reduce straining.
• Avoid rubbing your eyes; treat allergies that make the eyes itchy.
• Handle contact lenses carefully.
• Wear protective eyewear for sports and DIY.

Frequently asked questions

Is a burst blood vessel in the eye serious?

Usually not. Most subconjunctival hemorrhages are harmless, painless and clear within 1 to 2 weeks. It needs medical attention if it follows an eye injury, comes with pain or vision changes, keeps recurring, or appears with other bleeding.

How long does a subconjunctival hemorrhage take to go away?

Small ones usually fade in about a week and larger ones in 2 to 3 weeks. The patch often changes from red to yellow or green as it clears, like a bruise. People taking blood thinners may take a little longer.

Can high blood pressure cause a broken blood vessel in the eye?

Yes. High blood pressure is a recognized risk factor, especially when uncontrolled. A single bleed does not mean you have hypertension, but it is a good reason to have your blood pressure checked, particularly if bleeds recur.

Can stress cause a subconjunctival hemorrhage?

Stress itself does not directly break blood vessels in the eye. However, things linked to stress, such as eye rubbing, poor sleep, crying hard or straining, and raised blood pressure, can contribute.

Should I go to the ER for a broken blood vessel in my eye?

Not usually. Go to the ER if it follows a significant injury, if you have eye pain, vision loss or blood in the colored part of the eye, or if you have a sudden severe headache. Otherwise, it can be managed at home, with a routine check if it recurs.