This handout is for subconjunctival haemorrhage. Your care team identified this based on: bright-red, painless, flat, sharply demarcated patch under the conjunctiva with normal vision — the classic benign sch and the most reassuring red eye (tarlan & kiratli clin ophthalmol 2013 pmid 23843690; wills eye manual red-eye triage).
Other reasons your team may use this plan: spontaneous sch in a patient on warfarin / doac / antiplatelet — check inr; supratherapeutic anticoagulation is a real actionable cause; do not reflexively stop the agent (leiker optometry 2009 pmid 19410227; philip am j ophthalmol case rep 2021 pmid 33732947); recurrent or bilateral sch — pivot to bleeding diathesis / htn / occult trauma or nai (paediatric) / severe valsalva / conjunctival neoplasm in the elderly (tarlan & kiratli 2013 pmid 23843690; fierro/gresele clin chem lab med 2016 pmid 26087065); sch after eye/head trauma, severe valsalva (vomiting, coughing/whooping cough, labour, weightlifting) or contact-lens wear — trauma mandates open-globe exclusion first (mimura am j ophthalmol 2010 pmid 20709310; wills eye manual).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| reassurance_self_limited_resolves_1_to_2_weeks_no_specific_treatment | — | — | — | Tarlan & Kiratli Clin Ophthalmol 2013 (PMID 23843690) + Jeon Ophthalmic Epidemiol 2021 (PMID 34793286 — SCH itself is not a stroke/AMI risk factor) — isolated SCH is self-limited and needs NO specific treatment; resolves over 1-2 weeks (up to ~3 wk for large bleeds), colour evolves like a bruise. The therapeutic action is reassurance + return precautions. |
| cold_compress_first_24_to_48h_then_warm_compress | — | — | — | Wills Eye Manual — cold compress in the first 24-48 h to limit extension, then warm compress to speed clearance; mechanical/symptomatic adjunct only (no drug). |
| preservative_free_artificial_tears_if_surface_irritation | — | — | — | AAO PPP Conjunctivitis 2024 / Wills Eye Manual — lubrication only if the raised blood causes mild surface irritation; NOT a treatment for the haemorrhage itself; no topical antibiotic (no infection). |
Plan: Subconjunctival haemorrhage — reassurance / observation (no specific treatment) + conditional routed axes
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Education + return precautions are the core deliverable for benign SCH — explicit RED-FLAG return: new true ocular pain, any vision drop, discharge, severe photophobia, recurrence, bilateral involvement, or non-resolution by 3 weeks → re-present. Modifiable-driver follow-up where flagged: optimise BP, review/optimise (do not reflexively stop) anticoagulation with the prescribing clinician, contact-lens hygiene, treat the Valsalva source (e.g., antitussive / pertussis management). Recurrent/bilateral or persistent → ensure the bleeding-disorder / conjunctival-neoplasm / paediatric-safeguarding pathway is closed. For routed dangerous cases, ownership transfers to the receiving engine (Tarlan & Kiratli 2013 PMID 23843690; Fierro/Gresele Clin Chem Lab Med 2016 PMID 26087065).
Guideline: Tarlan & Kiratli — Subconjunctival hemorrhage: risk factors and potential indicators (Clin Ophthalmol 2013) as the canonical SCH risk-factor / work-up authority + Wills Eye Manual red-eye triage algorithm + AAO Preferred Practice Pattern Conjunctivitis (2024) for the SCH-vs-dangerous-red-eye danger-sign set + nationwide reassurance cohorts (Jeon Ophthalmic Epidemiol 2021 — SCH not a stroke/AMI risk factor; Hong Sci Rep 2023 — not associated with increased ICH/GI bleed) + recurrent-SCH haemostatic-yield evidence (Fierro/Gresele Clin Chem Lab Med 2016) + anticoagulant-associated SCH literature (Leiker Optometry 2009; Philip Am J Ophthalmol Case Rep 2021)