When blood appears in or around the eye, the sight can be alarming and immediately raise concerns about vision and health. The phrase “my eyes are bleeding” is a general description that can refer to several distinct conditions, ranging from a harmless surface bruise to a severe internal injury. Because the eye is a delicate organ, any visible blood requires prompt medical evaluation to distinguish between a minor issue and an emergency that threatens sight.
Identifying the Type of Ocular Bleeding
The first step in assessing a bloody eye is determining the location of the hemorrhage, as this visual cue is the most immediate indicator of severity. The most common form is a subconjunctival hemorrhage, which appears as a bright red patch on the white of the eye (sclera). This occurs when a small blood vessel breaks beneath the conjunctiva, the clear membrane covering the eye, allowing blood to pool on the surface.
A subconjunctival hemorrhage often looks worse than it is, typically causing no pain or change in vision. The blood is trapped externally and will be absorbed by the body over one to two weeks without treatment. Internal bleeding within the eye’s structure is far more serious and may not be immediately obvious on the surface.
Deeper bleeding can manifest as a hyphema, which is blood pooling in the anterior chamber—the space between the cornea and the iris. The blood often settles at the bottom of the iris or pupil, creating a visible fluid line that may block vision and cause pain or light sensitivity. A hyphema is typically caused by trauma and must be treated immediately to prevent complications such as permanent vision loss or glaucoma.
Another severe type is a vitreous hemorrhage, which occurs when bleeding enters the vitreous, the gel-like substance that fills the back of the eyeball. Since the blood is deep inside the eye, the patient experiences a sudden onset of floaters, cobweb-like shadows, or a significant decrease in visual acuity. This type of hemorrhage often signals a serious underlying problem, such as diabetic retinopathy or a retinal tear, and requires urgent specialty care.
Common Triggers and Underlying Causes
The rupture of blood vessels in the eye can be triggered by a sudden, sharp increase in venous pressure, which places strain on the delicate vasculature. Common actions that can cause a benign subconjunctival hemorrhage include violent sneezing, intense coughing, episodes of vomiting, or straining during heavy lifting or bowel movements. These Valsalva-type maneuvers cause temporary pressure surges that can burst the small vessels on the eye’s surface.
Beyond temporary pressure changes, direct trauma is a frequent cause of both superficial and internal bleeding, especially in cases of hyphema. Blunt force to the eye, such as from sports injuries or accidents, can cause a tear in the iris or ciliary body, leading to blood collecting in the anterior chamber. The presence of a foreign body or penetrating injury also carries a high risk of significant ocular hemorrhage.
Certain chronic systemic health conditions can weaken blood vessels, predisposing them to rupture even without direct trauma. Uncontrolled severe hypertension, or high blood pressure, makes vessels more fragile and is a common risk factor for both subconjunctival and deeper hemorrhages. Similarly, advanced diabetes can lead to the growth of abnormal, fragile blood vessels in the retina, known as proliferative diabetic retinopathy, which are prone to bleeding into the vitreous cavity.
Certain medications are also known to increase the risk of ocular bleeding by interfering with the body’s natural clotting mechanisms. Patients taking anticoagulant medications, commonly referred to as blood thinners, such as warfarin, or antiplatelet drugs like aspirin, are more susceptible to vessel rupture. These medications inhibit the body’s ability to seal the leak quickly, which can result in a more noticeable hemorrhage.
Triage: When Is It an Emergency?
While a bright red patch on the white of the eye is often harmless, the severity of ocular bleeding is determined by associated symptoms and the location of the blood. If the bleeding is confined to a spot on the sclera, is painless, and does not affect your vision, it is likely a subconjunctival hemorrhage that can be monitored. This type typically begins to fade and clear within a week or two as the body reabsorbs the blood.
However, certain signs demand immediate, emergency medical attention to prevent permanent visual impairment. Any visible blood that pools in the colored part of the eye, indicating a hyphema, is a medical emergency that requires prompt care to manage intraocular pressure. Similarly, sudden, significant vision loss, the appearance of numerous new floaters, or a sensation of a curtain over your vision suggests a vitreous hemorrhage or retinal detachment, necessitating an emergency room visit.
Additional symptoms that should prompt an immediate trip to the emergency room or an urgent call to an eye specialist include eye pain that is moderate to severe, persistent nausea or vomiting, or a headache accompanying the bleeding. These may indicate dangerously high pressure inside the eye, known as acute angle-closure glaucoma, or a more systemic issue like a hypertensive crisis. Bleeding that occurs following significant trauma to the head or eye should always be evaluated by a medical professional, even if the vision seems unaffected initially.
Urgent follow-up with an ophthalmologist within 24 hours is recommended if a subconjunctival hemorrhage is unusually large, involves the entire white of the eye, or is recurring without a clear, minor cause like a cough or strain. This recurring pattern may signal an undiagnosed underlying issue, such as severe, unmanaged high blood pressure or a previously unknown bleeding disorder that requires systemic treatment.
Professional Diagnosis and Treatment
The diagnosis process begins with a comprehensive eye examination to determine the location and extent of the blood. An eye doctor uses a slit lamp, a specialized microscope, to closely examine the anterior structures of the eye, including the cornea, iris, and anterior chamber. Checking intraocular pressure is essential, especially with a hyphema, as elevated pressure can lead to optic nerve damage and glaucoma.
For deeper bleeds, such as a vitreous hemorrhage where the back of the eye is obscured, imaging techniques are necessary to evaluate the retina. B-scan ultrasonography provides a clear image of the internal eye structures, allowing the doctor to check for a retinal tear, detachment, or the presence of a foreign body. These diagnostic tools help pinpoint the source and underlying cause of the hemorrhage.
Treatment for superficial subconjunctival hemorrhages is conservative, often involving only observation and possibly artificial tears to soothe irritation. For serious cases like a hyphema, the patient is prescribed eye drops to control inflammation and manage intraocular pressure. Standard management protocols include strict rest, wearing a protective eye shield, avoiding strenuous activity, and refraining from blood-thinning medications to prevent re-bleeding.
Severe or non-clearing internal hemorrhages may necessitate surgical intervention to restore vision. A pars plana vitrectomy is a procedure used to remove dense or long-standing blood from the vitreous cavity. This procedure is often indicated for chronic vitreous hemorrhages or those associated with retinal detachment. For bleeding caused by systemic conditions like diabetic retinopathy, treatment also focuses on managing the primary disease, potentially including laser photocoagulation to seal off abnormal blood vessels.