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Hyposphagma – Subconjunctival Hemorrhage Explained

Hyposphagma is a bleeding beneath the conjunctiva of the eye, causing a visible red patch. It is usually harmless and resolves on its own within a few weeks.

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Things worth knowing about "Hyposphagma"

Hyposphagma is a bleeding beneath the conjunctiva of the eye, causing a visible red patch. It is usually harmless and resolves on its own within a few weeks.

What is a Hyposphagma?

A hyposphagma (also called a subconjunctival hemorrhage) is a collection of blood between the conjunctiva (the thin, transparent membrane covering the white of the eye) and the underlying sclera (the white of the eye). It appears as a bright red or dark red patch on the surface of the eye. Although the appearance can be alarming, a hyposphagma is in most cases harmless and resolves without treatment.

Causes

A hyposphagma occurs when small blood vessels (capillaries) in the conjunctiva rupture and blood leaks out. Common causes include:

Mechanical factors: Rubbing the eye, foreign bodies, or minor trauma
Increased pressure: Intense coughing, sneezing, vomiting, or straining (e.g., during bowel movements)
High blood pressure (arterial hypertension)
Blood clotting disorders or blood-thinning medications (e.g., aspirin, warfarin)
Contact lens wear: Irritation from poorly fitting lenses
Ophthalmic procedures or eye examinations
Idiopathic causes: No identifiable cause (very common)

Symptoms

The hallmark of a hyposphagma is the sharply defined red patch on the white of the eye, which does not move with eye movement. Associated symptoms may include:

A mild sensation of pressure or a foreign body feeling in the eye
Little to no pain
No impairment of vision

Severe pain, visual disturbances, or trauma as a triggering event should always be evaluated by a medical professional.

Diagnosis

Diagnosis is typically made through a clinical eye examination. An ophthalmologist assesses the extent of the hemorrhage and rules out more serious underlying causes. If a systemic condition is suspected, the following tests may be performed:

Blood pressure measurement
Blood count and coagulation tests
Slit-lamp examination of the eye

Treatment

In most cases, no specific treatment is necessary. The blood is gradually reabsorbed by the body within 1 to 3 weeks, and the red patch typically fades from red to yellow-green before disappearing completely. Supportive measures include:

Cold compresses applied in the first few hours after onset
Lubricating eye drops to relieve dryness or irritation
Avoiding triggering factors such as rubbing the eye

If an underlying condition such as high blood pressure or a clotting disorder is identified, it should be treated to prevent recurrence.

When to See a Doctor?

Medical evaluation is recommended if:

The hyposphagma was caused by trauma or an eye injury
Visual disturbances or severe pain are present
The bleeding spreads to cover the entire eyeball
Hemorrhages occur repeatedly without an obvious cause
There is a known bleeding disorder or anticoagulant medication use

References

Grehn, F. (2019). Augenheilkunde. 32nd edition. Springer Medizin Verlag.
Kaufman, P. L., Alm, A. (Eds.) (2011). Adler's Physiology of the Eye. 11th edition. Saunders Elsevier.
American Academy of Ophthalmology (AAO) (2023). Subconjunctival Hemorrhage (Hyposphagma). Retrieved from: www.aao.org

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