Subconjunctival Hemorrhage; “Complication” of Vitrectomy?

Subconjunctival hemorrhage looks frightening but is really quite benign. It doesn't even hurt. Randall Wong, M.D., Retina Specialist, Fairfax, VA 22030A subconjunctival hemorrhage is quite frightening, but when following vitrectomy, it is quite benign.

Similar to a Bruise

A bruise of your skin and a subconjunctival hemorrhage are the same thing.  In both cases, blood is trapped beneath tissue.  The difference is that with the eye hemorrhage, the blood is trapped underneath very thin transparent tissue.

Hence, the bright red appearance.  There is no muscle or skin to mask the bright red color.

Causes of a Subconjunctival Hemorrhage

There are many causes of a subconjunctival hemorrhage.  The blood itself is benign, painless yet ugly.  The cause of the hemorrhage could be from an infection, inadvertent poke in the eye, cough/sneeze/strain, etc.  On rare occasion the bleeding could be a sign of systemic disease, hence, your doctor must be made aware of frequent or bilateral subconjunctival hemorrhages.

Bleeding Caused by Surgery

The intent of this article was to address the bleeding following vitrectomy or scleral buckle retinal surgery.

The conjunctiva is a very thin and relatively clear tissue and is the outermost covering of the eye.  It surrounds the beginning at the edge of the cornea.

The conjunctiva has lots of tiny blood vessels.  These tiny vessels are quite fragile and can bleed easily.  Many times I’ll use a cotton swab to push on the eye…it can bleed.

Most of the time, the bleeding is caused by directly poking or cutting through the fine delicate blood vessels of the conjunctiva as I am preparing the eye for surgery or as I am finishing up surgery.

While scary, it’s a frequent occurrence (I’m deliberately avoiding the word “complication”) and probably happens about 50% of the time.

It’s Scary, but Harmless

When related to surgery, it’s scary but harmless.  So many patients get over excited by the gruesome look.  It will go away, migrate with gravity and may even change color.  A subconjunctival hemorrhage usually takes 1-2 weeks for the blood to go away.

Blood must be broken down then absorbed by the body.  The by-products of the breaking down of blood can have different hues/colors/shades.

What Does This Mean?

A subconjunctival hemorrhage is benign.  It has no relationship to whatever is going on inside the eye.  Following surgery, it’s natural to get fixated on the appearance of the eye..that’ normal.  Rest assured, however, that it is a frequent occurrence in retinal surgery.

A subconjunctival hemorrhage does not occur so often with cataract surgery.  Modern cataract surgery requires incisions (cutting into the eye) through the cornea.  The cornea is devoid of blood vessels.

If you are concerned about bleeding on the outside of your eye, you should alert your doctor.

 

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