Eye bleeding refers to the presence of blood in or on the eye, not blood flowing out. It can range from benign spots to signs of serious underlying health issues. While a small red patch on the eye’s surface may appear alarming, it doesn’t always indicate a severe problem. Understanding the different forms of eye bleeding helps determine when to seek professional medical attention.
Types of Eye Bleeding
A subconjunctival hemorrhage involves a broken blood vessel just beneath the conjunctiva, the clear membrane covering the white part of the eye. This results in a bright red spot or patch on the sclera, which can appear dramatic but typically causes no pain or vision changes.
A hyphema is characterized by blood collecting in the anterior chamber of the eye, the space between the cornea and the iris. This blood can partially or completely block vision and often appears as a reddish layer at the bottom of the iris or pupil.
Deeper within the eye, a vitreous hemorrhage involves bleeding into the vitreous humor, the gel-like substance that fills the main cavity of the eyeball. Symptoms often include blurred vision, floaters, or a red tint to vision.
Bleeding can also occur within the retina itself, known as a retinal hemorrhage. This involves damage to the blood vessels in this light-sensitive tissue at the back of the eye. Retinal hemorrhages may present with sudden vision loss, blurry vision, or dark spots, and can affect one or both eyes.
Underlying Causes
Subconjunctival hemorrhages are frequently caused by sudden increases in pressure, such as from violent coughing, sneezing, vomiting, or straining during bowel movements. Even rubbing the eyes too forcefully can sometimes lead to these visible red spots. Certain medications, particularly blood thinners like aspirin or warfarin, can also increase susceptibility to subconjunctival hemorrhages by impairing blood clotting.
Systemic medical conditions can also contribute to eye bleeding, especially in more severe forms like hyphema, vitreous, or retinal hemorrhages. High blood pressure can weaken blood vessels, making them prone to rupture. Diabetes, particularly advanced diabetic retinopathy, can cause abnormal blood vessel growth or damage within the retina, leading to bleeding. Blood clotting disorders like hemophilia or von Willebrand disease compromise the body’s ability to stop bleeding, increasing the risk of spontaneous or prolonged hemorrhages in the eye.
Direct trauma to the eye is a common cause for more serious types of bleeding, such as hyphema, often resulting from a blow to the eye during sports or accidents. Penetrating injuries or blunt forces that increase intraocular pressure can cause tears in the iris or ciliary body vessels. Complications following eye surgery, such as cataract surgery, can also result in bleeding. Certain eye infections, inflammations, and some eye cancers are less common but possible causes of hyphema. In rare instances, severe underlying conditions like aneurysms, tumors, or vascular diseases such as retinal vein occlusions can manifest as eye bleeding, particularly retinal hemorrhages.
When Medical Help is Needed
Immediate emergency care is necessary if eye bleeding is accompanied by specific symptoms. These include any changes in vision, such as blurriness, sudden vision loss, or new floaters or dark spots. Eye pain, sensitivity to light, or double vision also warrant immediate medical evaluation. Bleeding after significant trauma to the head or eye, or accompanied by headache, nausea, or vomiting, should prompt an emergency visit.
A subconjunctival hemorrhage often resolves on its own within one to two weeks. However, consult a doctor if the bleeding is recurrent, does not clear within a few weeks, or if there is any concern about its cause. Provide details about when the bleeding started, associated symptoms, recent injuries, and a complete list of medications, especially blood thinners. Sharing relevant medical history, such as high blood pressure or diabetes, is also helpful.
Diagnosis and Treatment Overview
Diagnosis typically begins with a comprehensive eye examination. This often involves a slit-lamp examination, using a microscope with a bright light to view internal eye structures. An ophthalmologist may also perform fundoscopy to examine the retina and optic nerve. Additional tests may be ordered if an internal injury or underlying systemic condition is suspected.
Further investigations can include blood tests for clotting disorders, diabetes, or high blood pressure. Imaging studies, such as an eye ultrasound or CT scan, may be used for deeper internal bleeding or structural damage. For a subconjunctival hemorrhage, treatment is usually not required, as the blood is reabsorbed by the body over time.
More serious types of bleeding, like hyphema or vitreous hemorrhage, require specific management. Treatment principles often include rest, elevating the head to help blood settle, and avoiding activities that increase eye pressure or cause re-bleeding. Eye drops may be prescribed to manage inflammation, pain, or intraocular pressure. Managing underlying medical conditions, such as uncontrolled high blood pressure or diabetes, is a primary focus.
Temporary discontinuation or adjustment of blood-thinning medications may be considered under strict medical supervision. Surgical intervention may be necessary for severe cases, such as non-clearing hyphemas or significant retinal detachments caused by bleeding.