Subconjunctival bleeding
Subconjunctival bleeding, also known as subconjunctival hemorrhage or subconjunctival haemorrhage, is bleeding from a small blood vessel over the whites of the eye. It results in a red spot in the white of the eye. There is generally little to no pain and vision is not affected. Generally only one eye is affected.Natural causes can include coughing, vomiting, heavy lifting, straining to pass hard stools during acute constipation or the act of "pushing" or "bearing down" during labour/childbirth as these activities can increase the blood pressure in the vascular systems supplying the retina. There are up to four vascular retinal plexuses that are supplied by tiny, delicate capillaries whose walls if encountered with a sudden amount of force from blood will rupture. External causes can include direct impact/injury from an accidental bump or a physical altercation resulting in blunt force trauma. Risk factors include hypertension, diabetes, old age, and blood thinners. They occur in about 2% of newborns following a vaginal delivery. The blood occurs between the conjunctiva and the episclera. Diagnosis is generally based on the appearance.Generally no specific treatment is required and the condition improves in two to three weeks. Artificial tears may be used to help with any irritation. They occur relatively commonly. Both sexes are affected equally. Spontaneous bleeding occurs more commonly over the age of 50 while the traumatic type occurs more often in young males.

Signs and symptoms
A subconjunctival bleeding usually does not result in pain, although occasionally the affected eye may feel dry, rough, or scratchy.
A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within 2 weeks.

Causes
Mechanical
Increased venous pressure (e.g. extreme g-force, straining, vomiting, choking, coughing or strangling) or from straining due to constipation
External pressure changes:Atmospheric pressure changes due to aircraft altitude changes.
Mask squeeze from diving without equalizing mask pressure during descent or from diving deeply in water
Eye injury
Head injury
Laser eye surgery or other eye surgery
Zygoma fracture (results in lateral subconjunctival bleeding)
Medical conditions that cause increased venous pressure:
Whooping cough or other extreme sneezing or coughing
Severe hypertension
Medical conditions that affect blood or blood vessels:
Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
Coagulation disorder (congenital or acquired) including Ebola
Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
LeptospirosisSubconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency),abuse or traumatic asphyxia syndrome.

Diagnosis
Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye.

Management
A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged.

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