Doctor, I have a bright red spot on my eye! What do I do now (about a subconjunctival hemorrhage)?

PART 2

Once a blood vessel breaks, the short-term “fix” to limit blood flowing out and “bruising” the white of the eye, is anything that constricts the vessel (so it is letting less blood out).

-       Cold is a good constrictor – so a cold compress over the lids.

-       Ironically, drops like Lumify (but see above on this).

-       Lubrication of the surface, so preservative free artificial tears.

-       Light pressure (assuming you can press on the point where the blood is leaking from).

-       Avoiding blood thinners (if the bruise feels uncomfortable, taking aspirin, Advil, Aleve or any other blood thinning products – too numerous to list here – will cause blood not to clot and allow for a larger bruise).

-       Controlling blood pressure (so poorly controlled blood pressure will force more blood out of the broken vessel). Worry over the bruise might stir up the blood pressure, so try to relax.

My usual advice to a patient with a bright red spot on the white of their eye is –

-       Unless there is undue pain, decreased vision or recent surgery on their eye - to relax (& generally – they don’t need to rush in for an eye exam or treatment)

-       Stop blood thinners like oral oil supplements for a few days, aspirin (or other blood thinners – UNLESS prescribed by their primary care or heart doctor – then check with them first). Holding strong spices, exercise, and alcohol for a few days as this also helps reduce blood vessel dilation and reduces blood flowing out of the blood vessel.

-       If the “bruise” is particularly unsightly, consider wearing an eye shield (or sleep goggles) at night so you are less likely to rub it or press it directly against a pillow in a way that might re-injure the broken vessel. Don’t rub your eye!

-       Keep preservative-free artificial tears in the refrigerator and use them every few minutes as soon as you recognize the broken vessel. Once it is clearly not “growing,” then reduce the applications to hourly or less. The direct “cold” will constrict the vessel and sooth the irritation. The lubrication will reduce the friction. If you have a “eye whitening eyedrop” (Like Lumify) on hand, this could be one of the few times it is worth using it in a medical way – but sparingly and only for a day or two, to help stabilize the blood vessel and the clot that stops it from oozing.

-       If you recognize it the moment it happens (which is sometimes possible), then closing the lids and gently pressing over that part of the lid covering the area of bruising may help. Unfortunately, if you look around while doing this, then you may be rubbing over the vessel in a way that pumps more blood out – so keeping your eye closed and not moving your eye - while gently pressing for 30 seconds on and 10 seconds off - for a few minutes may help. Using a covered piece of ice to apply the pressure can be somewhat more helpful. After the first 24 hours, ice and cold is generally only useful for comfort and not useful to prevent further bruising.

-       If you are doing heavy lifting, coughing, sneezing, straining at bowel movements or vomiting, then the sudden rise in Blood Pressure can “blow out” a blood vessel – and those on the white of your eye are the more “visible.” Controlling BP has already been discussed and holding back on heavy lifting while healing the broken vessel can help. If the coughing is related to a cold or allergies and/or the sneezing is allergic, then something to reduce allergies and coughing can help. Stool softeners, laxatives and a healthy diet can help with straining. Vomiting, if ongoing, may be worth reaching out to your primary care doctor for an “anti-emetic” (a medicine to reduce vomiting).

-       If your eye doctor has recommended hot compresses, it is usually best to hold off for 5 days (allowing enough time for healing the vessel before dilating from the heat).

-       If your doctor has prescribed a steroid drop for your inflammation, then continuing that drop while nursing the broken blood vessel is worthwhile, as stopping the steroid risks rebound redness. The dilation of the vessels associated with rebound inflammation will cause the broken vessel to also dilate – and possibly to blow out the small clot that stopped the bleeding and allow more bleeding (and bruising) under that clear membrane we call the conjunctiva.

-       Most important – report these events to your dry eye specialist so they know this is going on. They usually will recommend treatments designed to improve your ability to produce more – and better – tears to aid in natural lubrication and in the support of the living surface of your eyes. If the conjunctiva has too much laxity and it is apparent that these loose folds are contributing to the breaking of these vessels (& can commonly contribute to dry eye symptoms – see my earlier posts on this) – then they may recommend a surgical repair (I’ve posted on simple plications). Working with a good dry eye specialist is important to all eye health!