Bloody Eye
Lately I’ve had an uptick in patients complaining of sudden eye redness, usually in one eye. They describe the eye as bloody or bloodshot. Sometimes frantic relatives would chime in that they “saw it bleeding.” Further history-taking would reveal that it occurred suddenly and painlessly. Some patients report some mild discomfort; otherwise no pain and no blurring of vision. What is this and what’s causing it?
There are different layers in the eye. We’re concerned with the area between the outermost layer of the eye (conjunctiva) and the layer underneath it (sclera). There are many tiny blood vessels in the conjunctiva, and because of their size these can easily break. A break causes blood to leak out into the space between the conjunctiva and sclera, causing the area to look bloodshot. This condition is called a subconjunctival hemorrhage.
Why do these blood vessels break and cause a leak? Again because of their size, these blood vessels are easily affected by changes in blood pressure/pressure within them. Any type of straining can cause this, such as hard coughing, sneezing, lifting heavy objects. Even bowel movement especially when constipated and you push with all your might.
Trauma can of course cause this too: towels can poke your eyes if you’re wiping your face with your eyes open. Vigorous eye rubbing can also lead to a subconjunctival hemorrhage. And let’s not forget, fisticuffs can give you a black eye and make it bloody red, too.
Infrequently, systemic illnesses can put you at risk for getting this — high blood pressure (hypertension); chronically elevated blood sugar in diabetes leading to more fragile blood vessels; intake of blood thinners like aspirin or warfarin. These blood thinner medications can cause not just subconjunctival haemorrhages but also bruises all over the body. Some patients may have a blood clotting disorder and may only get diagnosed of this because of repeated episodes of these haemorrhages or bruises that occur with almost no trauma.
Generally, subconjunctival haemorrhages are benign and the redness improves spontaneously without treatment over the next few days, depending on its size. Some patients feel some eye irritation and lubricants/artificial tears will help.
If episodes occur frequently or if there are accompanying symptoms such as pain, headache or blurring of vision, consult your eye doctor.
There are different layers in the eye. We’re concerned with the area between the outermost layer of the eye (conjunctiva) and the layer underneath it (sclera). There are many tiny blood vessels in the conjunctiva, and because of their size these can easily break. A break causes blood to leak out into the space between the conjunctiva and sclera, causing the area to look bloodshot. This condition is called a subconjunctival hemorrhage.
Why do these blood vessels break and cause a leak? Again because of their size, these blood vessels are easily affected by changes in blood pressure/pressure within them. Any type of straining can cause this, such as hard coughing, sneezing, lifting heavy objects. Even bowel movement especially when constipated and you push with all your might.
Trauma can of course cause this too: towels can poke your eyes if you’re wiping your face with your eyes open. Vigorous eye rubbing can also lead to a subconjunctival hemorrhage. And let’s not forget, fisticuffs can give you a black eye and make it bloody red, too.
Infrequently, systemic illnesses can put you at risk for getting this — high blood pressure (hypertension); chronically elevated blood sugar in diabetes leading to more fragile blood vessels; intake of blood thinners like aspirin or warfarin. These blood thinner medications can cause not just subconjunctival haemorrhages but also bruises all over the body. Some patients may have a blood clotting disorder and may only get diagnosed of this because of repeated episodes of these haemorrhages or bruises that occur with almost no trauma.
Generally, subconjunctival haemorrhages are benign and the redness improves spontaneously without treatment over the next few days, depending on its size. Some patients feel some eye irritation and lubricants/artificial tears will help.
If episodes occur frequently or if there are accompanying symptoms such as pain, headache or blurring of vision, consult your eye doctor.
Margarita Bondoc-Hermosa
Margarita Bondoc-Hermosa is an ophthalmologist practising in Metro Manila and the Visayas. She can be reached here:
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