The sudden appearance of blood in or around the eye is an alarming event. Ocular hemorrhage is the general term for any bleeding from the blood vessels located in or surrounding the eye structure. While the appearance can be frightening, the severity depends entirely on the source and location of the bleeding. Any episode of visible blood should prompt a visit to an eye care specialist or the emergency room. A professional assessment is needed to determine the exact cause and differentiate between a superficial, harmless event and a deeper, vision-threatening condition.
Understanding Surface Bleeding
The most common form of visible eye bleeding is a subconjunctival hemorrhage. This occurs when a tiny, fragile blood vessel breaks beneath the conjunctiva, the thin, clear membrane covering the white part of the eye, called the sclera. Since the blood is trapped between the conjunctiva and the sclera, it spreads out, creating a bright red patch that looks dramatic.
The rupture of these small capillaries is often triggered by sudden, temporary increases in venous pressure. Common causes include forceful sneezing, prolonged coughing fits, vomiting, or straining during a bowel movement or heavy lifting. Minor trauma, such as aggressive eye rubbing, can also lead to a break in these surface vessels.
This type of surface bleeding rarely causes symptoms beyond noticeable redness, though some people report a mild scratchy or gritty feeling. The condition is self-limiting, resolving on its own without requiring treatment. Like a bruise, the blood is gradually reabsorbed by the body over one to three weeks.
During the resolution process, the bright red patch may change color, darkening to a deeper red and then turning yellowish before completely disappearing. While the hemorrhage itself is benign, recurrent subconjunctival bleeding may sometimes signal an underlying issue, such as uncontrolled high blood pressure or a bleeding disorder.
Causes of Internal Eye Bleeding
Bleeding that occurs inside the globe, known as intraocular hemorrhage, is more serious as it can directly impair vision and threaten eye health. One type is a hyphema, which is the collection of blood in the anterior chamber, the space between the cornea and the iris. This accumulation often results from blunt or penetrating trauma that tears blood vessels in the iris or the ciliary body.
The blood in a hyphema typically settles toward the bottom of the anterior chamber, sometimes creating a visible layered effect. Beyond trauma, hyphema can also occur spontaneously due to certain systemic conditions. These include sickle cell disease, hemophilia, or the growth of abnormal, fragile vessels on the iris, which is a complication often associated with advanced proliferative diabetic retinopathy.
Another serious form of internal bleeding is a vitreous hemorrhage, where blood leaks into the vitreous humor, the clear, jelly-like substance filling the large space at the back of the eye. The most frequent cause of this bleeding is proliferative diabetic retinopathy, where new, weak blood vessels grow on the surface of the retina and rupture easily.
Vitreous hemorrhage can also be caused by a retinal tear, which occurs when the vitreous gel pulls away from the retina, causing a vessel to break. Trauma is another major cause, particularly in younger individuals. A rare condition known as Terson’s syndrome, where intracranial pressure from a brain hemorrhage forces blood into the vitreous, can also cause this bleeding.
When Bleeding Requires Immediate Medical Attention
While a simple surface hemorrhage is usually harmless, any ocular bleeding accompanied by additional symptoms should be treated as a medical emergency. Immediate attention is required if the bleeding is associated with eye pain or tenderness. This pain suggests a more serious injury or a rapid increase in intraocular pressure, which can damage the optic nerve.
A sudden change in vision is another red flag, including blurriness, the appearance of new floaters, or a partial or complete loss of sight. These visual symptoms indicate that the bleeding has likely occurred inside the eye, obscuring the light path to the retina. Bleeding that happens immediately following a blow to the head or eye trauma necessitates an urgent evaluation to rule out internal structural damage.
Secondary symptoms like nausea, vomiting, or a severe headache alongside the bleeding can signal acutely elevated pressure within the eye. An ophthalmologist will assess the situation by conducting a thorough examination, including measuring intraocular pressure and visualizing internal structures. Early diagnosis and treatment are paramount for internal hemorrhages to prevent long-term vision loss.