Blood in eye can signify various clinical conditions. These include subconjunctival hemorrhage, hyphema and vitreous hemorrhage. Each of these conditions can be due to various causes, and therefore, has a unique management protocol.
Blood in Eye: Subconjuntival hemorrhage
Blood in “white part of the eye”
A subconjunctival hemorrhage, or bleeding under the conjunctiva, is a very common cause of a painless blood in eye. Usually, you will either notice a blood shot eye when looking in the mirror, or will be told by someone else that your eye is bleeding.
Causes of subconjunctival hemorrhage
A break in one or more small blood vessels, just under the transparent to milky outermost covering of the eye, results in the bleeding. This blood in eye (which may be as little as a drop) gets trapped underneath the conjunctiva, much like the blood in a bruise is trapped in the skin.
A subconjunctival hemorrhage can occur due to:
- Trauma
- High blood pressure
- Lifting heavy weights
- Violent coughing or sneezing
- Viral infections like adenoviral conjunctivitis
- Vomiting
- Bleeding disorders
- Use of blood thinners like aspirin, coumarin and heparin
- No apparent reason.
Treatment of subconjunctival hemorrhage
Even though you may find the blood in eye frightening, the condition is not dangerous, and does not impact your vision. The blood shot eye will change colors just like a bruise in the skin, and may turn brown or green. Your eye will returns to normal within 3 weeks as the blood gets absorbed. Therefore, a subconjunctival hemorrhage does not require any treatment.
However, if the subconjunctival hemorrhage is accompanied by symptoms such as pain in the eye, or a drop in vision, your doctor may decide to investigate further. In case the hemorrhage recurs, your doctor will again want to look for a cause.
Blood in Eye: Hyphema
Blood in ”brown/ blue part of the eye”
The anterior chamber normally contains a clear liquid fluid called aqueous humor, which circulates via the pupil into the posterior chamber of the eye. Bleeding in the anterior chamber, which is the area between the cornea and the iris, is called a hyphema. This is one of the two kinds of “inside the eye” bleeding, the other one is called vitreous hemorrhage.
Causes of hyphema
The causes of blood in the anterior chamber of the eye include:
- Blunt trauma to the eye due do fall, sports injury, fights
- Abnormal blood vessels on the surface of the iris (often due to Diabetes)
- Eye infection caused by the herpes virus
- Bleeding disorders such as hemophilia and sickle cell anemia
- Use of blood thinners like aspirin, coumarin and heparin
Symptoms of hyphema
In case of a hyphema, you may experience one or more of the following symptoms:
- Pain in the injured eye
- Blurred vision
- Increase in eye pressure called glaucoma
- The eye may look like the “brown or blue part or iris” is filled with blood
- Sometimes the hyphema may even be asymptomatic.
Treatment of hyphema
Hyphema is a medical emergency, and may result in loss of vision. You must see your ophthalmologist immediately. In case of hyphema following trauma, your doctor will look for any other signs of injury. You may require certain imaging like Xray, CT scan or ultrasound of the eye, so that your doctor can assess the exact damage. Your doctor will also pay special attention to your eye pressure measurement.
Usually, doctors recommend steroid eye drops and some eye drops to lower the eye pressure (anti glaucoma medication). In case of associated eye injuries, your doctor will manage those as well. On the other hand, if the hyphema is because of the use of blood thinners, your ophthalmologist will discuss stopping these drugs with your general physician or cardiologist.
Sometimes, when hyphema is very large, or associated with very high eye pressures, your eye doctor will consider surgery to remove the blood from the eye. This procedure is called drainage of hyphema, and is not required usually.
Blood in Eye: Vitreous hemorrhage
Blood “inside the eye” or “invisible blood in eye”
Vitreous is the clear gel inside your eye, which fills up the space between the iris and the retina. Normally it is a clear gel, and light can pass through it to your retina. The retina is light sensitive lining at the back of the eye. Vitreous hemorrhage is the leakage of blood in the vitreous. It is the second of the two causes of “bleeding inside the eye”. However, unlike subconjunctival hemorrhage and hyphema, this bleed in eye is not visible externally.
Causes of vitreous hemorrhage
Any bleed in eye can allow blood to leak into the vitreous. Possible causes include:
- Diabetic retinopathy: Uncontrolled diabetes results in the formation of new, abnormal blood vessels on the retina that are fragile. These can bleed and leak fluid in the retina, as well as the vitreous.
- Trauma: Both, penetrating injuries and blunt trauma can cause a bleed in eye, including vitreous hemorrhage.
- Posterior vitreous detachment: With age, the gel-like vitreous degenerates and pockets of fluid form in it. The gel then collapses. The gel exerts a pull on the retina, since it is attached to it loosely. Consequently, it may cause holes or tears and bleeding.
- Bleeding in the brain
- Bleeding disorders
Symptoms of vitreous hemorrhage
In case of a vitreous hemorrhage, you may experience one or more of the following symptoms:
- Blurred vision
- Floaters, which may be like black “flies” or cobwebs.
- You may notice a reddish tint to your vision.
- You may notice bright flashes of light, even in the dark. This is because of the vitreous gel pulling on the retina. This may lead to a retinal tear or hole, along with a fresh bleed. Therefore, you must see your doctor in case of these symptoms.
Treatment of vitreous hemorrhage
Your doctor will first find out the cause of the vitreous bleed. You will undergo a dilated retinal evaluation, and may also need an ultrasound, CT scan or other imaging. After that, he will plan your treatment. This can be surgery to stop the bleeding or to remove the blood from the eye. This may include laser treatment, cryotherapy (freezing part of the bleeding blood vessel), or vitrectomy (surgery to remove the vitreous and blood from the eye).
