Subconjunctival Hemorrhage in Newborns

A subconjunctival hemorrhage is essentially a burst blood vessel in the white of the eye. It is one of several different disorders collectively known as “red-eye.”

The whites of the eyes—called the sclera—are covered with a thin, clear membrane called the bulbar conjunctiva. A subconjunctival hemorrhage 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 happen 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.

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.

Though the healing process is simple, it is still important to follow up with your primary care provider, as they will be able to monitor the healing process and make sure that more serious complications, such as cranial hematomas, are not developing. In some extremely rare cases, subconjunctival hemorrhage 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

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.

Further Reading

Lip and Face Edema Due to Face Presentation by Hülya Özdemir et al., The Journal of Pediatric Research, 2018.
This case study explains some of the ways in which childbirth trauma can cause injuries to the face. The text briefly explains that subconjunctival hemorrhage can occur as a result of nasal septum dislocation or pressure from the mother’s symphysis pubis or sacral promontorium.

Birth-related subconjunctival and retinal haemorrhages in the Newborn Eye Screening Test (NEST) Cohort by Marco Ji et al., Eye, 2019.
This study, conducted at the Lucile Packard Children’s Hospital at Stanford University’s School of Medicine, compared subconjunctival and retinal hemorrhages. Researchers concluded from their findings that retinal hemorrhages are more associated with the use of tools like forceps while 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. 9% of infants born had subconjunctival hemorrhages.

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 subconjunctival hemorrhage, child abuse should be on their list of potential causes.