Subconjunctival Hemorrhage in Newborns

A subconjunctival hemorrhage in a newborn is a burst blood vessel in the white of the eye. It is one of several different disorders known as “red-eye.”  It looks terrifying when a baby has this injury.  But

The whites of the eyes—called the sclera—are covered with a thin, clear membrane called the bulbar conjunctiva. A subconjunctival hemorrhage ("SCHN") occurs when tiny blood vessels rupture and bleed leaks inside of the conjunctiva. The ruptured vessels appear as a bright red spot on the surface of the eye.

What Causes Subconjunctival Hemorrhages in Infants?

Subconjunctival hemorrhages are somewhat common and can happen to people of all ages. For adults, the cause could be something as simple as coughing too hard. No matter the cause, a sudden change in pressure is what causes the blood vessels to burst. That is why, in some cases, a subconjunctival hemorrhage could be a sign of high blood pressure.

Although they can happen to people of all ages, it is common for newborns to get subconjunctival hemorrhages. Their occurrence is common in infants due to stressful and traumatic deliveries. Changing and forceful pressure during birth can cause eye blood vessels to burst.

Pressure put on the infant by labor contractions and delivery often causes subconjunctival hemorrhages in newborns because pressure forces blood pressure to abruptly rise, pushing blood vessels to the breaking point. High birth weight may put infants at more risk for this kind of injury.

It is also possible that these hemorrhages in newborns occur when OBGYNs exert force while attempting to deliver a baby that is stuck or otherwise in distress during labor and delivery. Subconjunctival hemorrhages are thought to be more likely to occur when certain birthing tools are used, such as forceps or a vacuum extractor.

Finally, if the umbilical cord was tight around the newborn's neck, you will see a greater likelihood of SCHN. 

What Are the Symptoms of Subconjunctival Hemorrhages and How Are They Treated?

It is understandably alarming to see a red patch on your newborn’s eye. Fortunately, this is the only symptom of common subconjunctival hemorrhages. In a standard case, there is no pain or complications caused by the condition.

Over the course of a week or two, the sclera will absorb the red blood cells and the mark will disappear. If your baby’s eye turns yellow as the blood vessels heal, there is no cause for alarm, as this is a normal part of the healing process.

The best thing that you can do as a parent is to keep an eye on the red patch as it heals. As it heals, the eye may itch occasionally, which can be treated with over-the-counter eye drops.

Should You Be Concerned About a Subconjunctival Hemorrhage in a Newborn?

As dreadful as a subconjunctival hemorrhage looks, it is almost always harmless. Ultimately, subconjunctival hemorrhages are a fairly common and nonthreatening occurrence in newborn infants. As long as you monitor the healing process of your baby’s eye and look out for any strange symptoms, your baby should be healed in no more than a week or two.

Still, keep an eye on it and keep your pediatrician in the loop.  There is an extremely rare risk of more serious complications, such as cranial hematomas, are not developing. In some extremely rare cases, SCHN may lead to some permanent eye damage. Treatment for these cases will depend on the severity of the condition.

If your child shows symptoms of a serious complication, you should contact your healthcare provider or an opthalmologist immediately. These symptoms include:

  • Signs of an eye infection, e.g. pus or thick discharge, redness, swelling, fever
  • Blood located anywhere other than the whites of the eyes
  • Changes in or problems with your child’s vision
  • Significant eye pain

You should also know that even if the SCHN is not a concern by itself, it is a marker more serious birth injuries because a co-traveler with SCHN is often a traumatic birth. 

Further Reading

Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort by Marco H. Ji, et. al, Eye, 2019. 

This study argues that the medical literature has exaggerated the degree to which these eye hemorrhages are linked to birth trauma.  The authors believe this complication is more likely caused by chest compression when the infant passes the birth canal with a sudden increase of venous pressure in the baby's neck and head. 

This Stanford study compared subconjunctival and retinal hemorrhages. The findings were that retinal hemorrhages are more associated with the use of tools like forceps. But, again, contrary to the literature, they found subconjunctival hemorrhages are more associated with high birth weights that cause the chest to compress during delivery, suddenly increasing blood vessel pressure in the neck and head.  Nine percent of newborns had SCHN in the study.

Lip and Face Edema Due to Face Presentation by Hülya Özdemir et al., The Journal of Pediatric Research, 2018.

This case study explains how childbirth trauma can cause injuries to the face. The text briefly explains that SCHN can occur as a result of nasal septum dislocation or pressure from the mother’s symphysis pubis or sacral promontorium.

Prevalence and Causes of Subconjunctival Hemorrhage in Children by Alomi O. Parikh, et al., Pediatrics, 2020. 

This cross-sectional study looked at subconjunctival hemorrhage’s prevalence and causes in children. The researchers’ data comprised over 33,000 children who visited pediatric ophthalmologists over 86,000 times in four years. They identified 949 subconjunctival hemorrhage cases. Eye surgery caused 636 of these cases. The researchers also found that non-surgical causes included trauma, ocular surface inflammation, conjunctival lesions, and choking or coughing-induced vessel ruptures. 

Subconjunctival Hemorrhage in a Child with the Blue Rubber Bleb Nevus Syndrome on Treatment with Oral Propranolol by Karen De Loecker, et al., Case Reports in Ophthalmology, 2021. 

This case report looked at a 3-year-old boy with blue rubber bleb nevus syndrome (BRBNS). He developed subconjunctival hemorrhaging in his left eye while taking oral propranolol. An underlying vascular malformation caused his subconjunctival hemorrhaging.  He treated the condition with topical timolol maleate.  The boy’s symptoms resolved after four months. The researchers recommended that children with BRBNS undergo ophthalmic screening. They also concluded that topical beta-blockers could treat BRBNS-related subconjunctival hemorrhaging. 

Subconjunctival hemorrhages in infants and children: a sign of nonaccidental trauma by Catherine DeRidder et al., Pediatric Emergency Care, 2013. 

This study explains that, sadly, subconjunctival hemorrhages are sometimes caused by intentional trauma, or in other words, child abuse. The condition can be caused by things like pressure to the chest and strangulation. When doctors diagnose SCHN, child abuse should be on their list of potential causes.