Blood in the Eye: How Alarmed Should You Be When Your Eye White Is Scary Red?

A subconjunctival hemorrhage is a burst blood vessel in the white part of your eye. It’s sometimes called a blood spot. Usually caused by a minor injury or strain, a subconjunctival hemorrhage that doesn’t linger or come back repeatedly is almost always harmless, even if it doesnt look that way.

A subconjunctival hemorrhage can be confusing, scary, and pretty impressive looking if youve never seen it before, but its rarely anything to worry about, says Emily Witsberger, MD, an assistant professor of ophthalmology at Baylor College of Medicine in Houston.

What Is a Subconjunctival Hemorrhage?

A pool of blood has collected right underneath the clear layer of the eye, and it shows up as completely red, like the surface of a tomato, Dr. Witsberger says.

Like a bruise, the mark normally fades over days or weeks, changing from red to purple, then from green to yellow.

• Diabetes
• Hypertension, or high blood pressure
• Hyperlipidemia, or high cholesterol
• Other vascular issues

What Causes a Burst Blood Vessel in the Eye?

Some of the more common ways in which blood vessels in your eye could break include:

• Straining People who engage in weightlifting, or those who have a condition that makes them more likely to be constipated, are the kinds of patients we see frequently, Witsberger says. Straining to have a bowel movement, energetic coughing, sneezing, vomiting, laughing, and crying all may create the kind of internal pressure that could prompt bleeding in the eye.
• Holding Your Breath Taking a deep breath and bearing down is called a Valsalva maneuver, which nudges a runaway heartbeat into a normal rhythm.
• Injury Sports lead the pack when it comes to eye-threatening injuries. Basketball, for instance, accounts for 31.6 percent of recreational injuries. Water sports, baseball, and racquet sports also may include a risk of eye injuries. Certain extreme leisure pursuits, such as bungee jumping or zip-lining, also pose a risk to the eyes because of pressure changes.
• Contact Lenses Blood spots are common among people who wear contact lenses. The pressure from taking lenses in and out sometimes can cause issues.
• Systemic Conditions Having high blood pressure (hypertension) and diabetes may increase your risk of getting a subconjunctival hemorrhage. Frequent or recurring blood spots in your eye also may be a symptom of hypertension, as well as of leukemia or blood-clotting disorders such as hemophilia or von Willebrand disease.
• Medication Any drug that inhibits blood clotting can raise the risk of a blood spot. The most popular anticoagulants, or blood-thinning medications, are heparin and warfarin (Jantoven).
• Eye Surgery When theres been any trauma to the eye, including through surgical manipulation, it can lead to subconjunctival hemorrhage, Witsberger says. Cataract surgery, refractive (vision-improving) procedures, and local eye anesthesia can lead to a blood spot.

How Is Subconjunctival Hemorrhage Diagnosed and Treated?

With or without treatment, the typical subconjunctival hemorrhage will quietly and completely vanish.

An eye doctor can figure out if the redness is the result of blood trapped under your conjunctiva or dilation of blood vessels, which can result from other conditions.

If youve taken a strong blow to your eye, your vision is affected, or blood spots keep coming back, your eye doctor may suggest other tests. You also may get a referral to another healthcare professional to check your blood pressure, blood count, or clotting ability.

What Over-the-Counter Products Should You Avoid?

Witsberger advises against using drops designed to counter red or bloodshot eyes.

They constrict blood vessels in the eye, and when you stop taking them, there can be a profound rebound effect, where the eyes become very red, she says.

If you regularly takenonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief or any medication that may thin your blood, ask your doctor if the medicine may interfere with the healing of a subconjunctival hemorrhage.

The Takeaway

• A burst blood vessel or bruise in your eye, known as a subconjunctival hemorrhage, is often harmless and can go away in a few weeks without treatment.
• A bloody eye may have no distinct cause, but it could be the result of an everyday injury, medications, contact-lens use, or systemic conditions.
• People ages 50 and older are more prone to developing blood spots in their eyes spontaneously, although diabetes, high blood pressure, and high cholesterol can contribute.
• A doctor can help determine if a bloody spot in your eye is cause for concern.