I will begin with a bit of background and why I chose this title. A couple of weeks ago I had a bloodshot eye, it wasn't bad and I didn't give it much thought. When I went to bed Sunday night it seemed quite a bit better. However, when I woke Monday morning and looked in the mirror, I got a big surprise. The eye was far worse with blood covering the white of the eye and what looked like some small black spots. I had no pain, no change in vision, but of course ,I panicked. Instead of "Manic Monday" a song by the American pop rock band The Bangles in the 1980's, I was thinking this was a panic Monday. All of us with diabetes know that our eyes are subject to damage as the control and duration of the disease progresses and I have always feared loss of sight just like everyone else.
My husband took me to the Emergency Room just in case it was more serious than an ordinary bloodshot eye. After a three hour wait, we saw the health-care team. They looked in the eye, asked a lot of questions and of course any background that I could offer which may have triggered this to happen. I could not relate any activity to be the cause. After a few minutes, and a bit of research by the care team I was told I was experiencing what is known as " Subconjunctival hemorrhage".
Subconjunctival hemorrhage refers to the appearance of one or more blood spots appearing on the white of your eye (sclera). There are many tiny blood vessels in the conjunctiva (the membrane that lines the eyelid and eye surface) of the eye. If these vessels break, then blood can leak between the conjunctiva and sclera (the tough outer layer of the eyeball referred to by many as the white of the eye). Because the leaking blood spreads out under the conjunctiva, it causes the white of the eye to appear a bright red. These blood spots can look scary and I can't argue with this statement.
Subconjunctival hemorrhage (SCH) can occur as a result of either trauma or it can be spontaneous. Traumatic causes might include previous eye surgery such as cataract surgery or Lasik surgery ( a laser is use to reshape the cornea).
Spontaneous causes include eye rubbing or foreign body in the eye. High blood pressure and other vascular disorders like diabetes and high lipid levels are two of the biggest risk factors. Coughing, sneezing, straining may cause a hemorrhage. People who take anticoagulation therapy (therapy to inhibit or slow down the coagulation of the blood) might be at a higher risk for SCH. This certainly explains why I was asked the questions about blood pressure, any new or different activity and a medication history.
SCH in general does not favour one gender over the other. It increases with age (>50) perhaps because the older we are the higher probability of comorbidities such as high blood pressure, high lipid levels and the presence of diabetes.
SCH is usually painless, acute and occurs most often just in one eye. There is no reduction in visual acuity. Like me, you may only be aware of it if you look in the mirror or someone else tells you.
Unless there is an associated serious condition, treatment is not required. The blood is resorbed over 1-2 weeks depending on the amount of blood that leaked into the space. Mine did disappear within this time period. If there is any discomfort, ice packs and artificial tears may provide some relief.
Visual prognosis after resolution is good and vision is generally not impaired. The recurrence rate for spontaneous SCH is around 10% and higher in patients who use medicines to thin the blood like aspirin and anticoagulation drugs. Complications are rare but it they do arise, this could be a warning sign of a more underlying serious condition and therefore needs to be assessed by the health care team.
It is safe to continue with your normal exercise routine or work, but while the eye is healing perhaps taper or lessen extremely strenuous exercises or activity. This is exactly what I was told and which I did follow. I even limited my computer screen time just to be sure I wasn't aggravating the issue, but this is just me being extra cautious. I was not advised to do this.
Since this was new to me, I thought I would share my experience. The appearance was awful but I was so happy that it wasn't serious. However, if it occurs frequently in anyone please visit your health care team. I did see my eye specialist and he confirmed what I had been told and I do have a follow-up in one month.
The above information is not intended to replace any medical advice you may have received. Its'intent is for information purposes only. References:
2)Image- Google images (Creative Commons )
3)Doshi R, Noohani T. Subconjunctival Hemorrhage. [Updated 2022 Feb 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551666/
Great blog, Karen! I really appreciate the information you share...