Repeated subconjunctival hemorrhages

[Juliet1971]

I'm a 44 year old woman, overweight, no other major health issues. Have had dry eyes for years and use a lot of OTC drops. For the past two years, I've had recurring subconjunctival hemorrhages, about every few months. No other weird bleeding or bruising. Saw ophthalmologist in December when I had one and she assured me not to worry (told her they kept happening). Saw GP in January for routine exam and told him. He did CBC and basic bloodwork and all fine. Blood pressure is high in doc's office, but I have major white coat syndrome. Often, I can trace hemorrhage to an event that has me very stressed out, super high anxiety, doing heavy lifting. Last couple of weeks have been VERY stressful. Had one small bleed last week and yesterday that same spot bled again. Called ophthalmologist and they had a cancellation for today so I'm going to get looked at again. I feel like they might just be pacifying me since this has me super stressed out. It looks gross and I can't shake that it might be something serious. Is it most likely BP related (I need to figure out if this is white coat syndrome or really this high normally!)? Google has me scared of leukemia, vasculitis, other systemic things. If routine bloodwork fine in January, should I ask for any additional testing?
Thanks for advice!

[JohnHaganMD]

best of luck
JCH MD

[Juliet1971]

Appreciate the advice! Going to ophthalmologist today and will ask if any additional bloodwork is needed. Yes, need to lose weight for sure.

[JohnHaganMD]

Subconjuctival hemorrhages (SH) are extremely common and rare is a week I don't see one or two and its the same for the other ophthalmologists and optometrists in our office. I won't say I'm happy to see them but I'm happy that I can almost always reassure them its not something serious. (I've had 2 or 3 over the years).  We do ask about bleeding tendencies and I ask to see their arms to be sure not covered in bruises; I ask about 'free bleeding" and of course we always ask if they are on major blood thinners like warfarin (Coumadin).  If the ARE we ask when they have had their last test for proper thinness (test called INR). If greater than a week or history of being "too thin" we have them see their family MD or cardiologist right away.

Otherwise we tell them the blood vessels on the surface of the eye are delicate, numerous and prone to "pop" during heavy bending, stooping, lifting, inversion (think yoga), heavy exercise or sometimes for no good reason.  We outline the eye will be back white as usual but it takes a couple of weeks.

For the isolated case of SH or maybe 2 in one year that's all that's necessary. For repeated like yourself we would recommended  1. a complete eye exam by an ophthalmologist 2. a physical exam with appropriate blood work by your personal physician.

If all of those are normal, and you eat a good diet (remember lutein is important to the eye and found in green leafy green foods like spinach and kale. They also contain Vitamin K which makes the blood "thicker" and less likely to free bleed)  Then I would suggest you work on losing weight (the excess weight increases pressure in the veins (Valsalva maneuver), its unhealthy and contributes to your blood pressure.  You need to do a lot of blood pressure readings at home with an automated arm cuff and if you are hypertensive or pre-hypertensive discuss with your family MD treating the HBP.

The person I've taken care of with the most SH in once year was a neighbor who was a general surgeon. He had 4-5 big ones and he was perfectly healthy and his blood work perfect. Next year they stopped completely

JCHMD