FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

BRIGHT RED SPOT IN READER’S EYE WILL PROBABLY GO AWAY IN A WEEK

Question: I woke up one morning last week with a bright red spot in the white part of my eye. It didn’t hurt and I could see fine. I went to the doctor and she said it would just go away. Was she right? What caused this? Will it happen again? It is a symptom of some serious illness?

Answer: It sounds like you had a subconjunctival hemorrhage. This disorder involves bleeding from the small capillaries in the white part of your eyeball. Your experience is fairly classic since most people first discover they have this condition when they get up in the morning and look in the bathroom mirror. It’s also not too uncommon for someone else to first notice this condition and say, with a great deal of concern, “What happened to your eye!!?”

Before telling you more about this condition, let me explain the meaning of the term subconjunctival hemorrhage. The white area of the eye is covered by a delicate, transparent membrane known as the conjunctiva. Since the small blood vessels that break open and bleed in this condition are located underneath this conjunctiva, the word “sub” is used to connote “below.” Hemorrhage means the escape of blood from a vessel. Hence, the two terms together -- subconjunctival hemorrhage -- mean bleeding below the conjuctiva.

Subconjunctival hemorrhages usually have no symptoms. There is no eye pain or change in your vision. Your pupil is normal and reacts normally to changes in light intensity. The bright red spot in your conjunctiva is believed to be caused by some sort of minor trauma to the eyeball. The types of trauma that can cause these small, delicate blood vessels to rupture include rubbing your eye during sleep, forceful sneezing or coughing, straining when going to the bathroom, and lifting.

These hemorrhages are also seen relatively frequently in newborn infants, and they often appear as a bright red, sickle-shaped hemorrhage on the white of the eye. They are thought to be caused by the relatively violent pressure changes across the length of the infant's body during delivery.

Subconjunctival hemorrhages are more common in people who are taking anti-coagulant medications such as coumadin. In rare circumstances, these hemorrhages are associated with severe, uncontrolled high blood pressure. In these cases, however, the person would usually have other symptoms as well, such as a headache.

This is a straightforward diagnosis for an experienced practitioner. Your doctor probably conducted a thorough exam of your eyeball that revealed no findings other than the red spot. She also determined that you have normal vision, no eye pain, and hadn’t had any major trauma to the eye. She probably also checked your blood pressure.

Treatment is usually limited to supportive care such as cool compresses. If there is an associated condition that is causing coughing or sneezing, that should be treated as well. Generally the globe of the eye (eyeball) will fully clear in 7 to 10 days with no treatment.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.