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You look in the mirror and one eye has a vivid red patch across the white — no pain, no warning, no obvious reason. It is one of the most frightening things an eye can do, and one of the most common reasons people rush to an eye clinic convinced something serious has happened. The reassuring truth is that a flat red patch on the white of the eye, a subconjunctival haemorrhage, is almost always a harmless burst blood vessel that clears on its own. The skill is in telling this benign blood spot apart from the few red-eye situations that genuinely need attention. The short answer A subconjunctival haemorrhage is a small amount of blood trapped just under the clear surface film of the eye — like a bruise on the white of the eye. It usually looks far worse than it is: it does not affect your vision, does not hurt, and does not threaten the eye. Most appear for no clear reason or after a cough, a sneeze or a rub, and they fade over one to two weeks, changing colour like any bruise. The situations that do need prompt attention are different: a red eye with pain, light sensitivity, reduced vision, discharge, or after a real injury — or blood spots that keep coming back. What a subconjunctival haemorrhage actually is The white of the eye is covered by a thin, transparent membrane called the conjunctiva, which carries tiny, delicate blood vessels. If one of these vessels breaks, a little blood escapes and spreads out flat underneath the membrane, where it cannot drain away quickly. Because it sits under a clear film, it shows up as a bright red, sharply outlined patch on the white of the eye. The blood is on the surface — it is not inside the eye and not near the part you see with — which is exactly why vision stays perfectly normal. Why it looks so alarming — but usually is not A blood spot can cover a large part of the white and can even bulge slightly, so people understandably assume the worst. But a true subconjunctival haemorrhage has a very reassuring signature: it is painless, does not blur vision, produces no discharge, and is not gritty beyond a mild awareness. There is nothing you have done wrong, and the blood cannot “spread into the eye” or damage sight. The colour will actually look worse for a day or two as the blood spreads out before it starts to fade — this is normal. Common causes: often for no reason at all In many people a blood spot appears completely spontaneously, with no identifiable trigger. When there is a cause, the usual ones are: A sudden pressure surge (Valsalva): hard coughing, sneezing, vomiting, straining on the toilet, or heavy lifting can pop a small vessel. Minor trauma or rubbing: vigorously rubbing the eye, a stray finger, or a small knock — and contact-lens handling. High blood pressure: particularly in older adults and when blood spots keep recurring. Blood-thinning medicines: aspirin, clopidogrel, warfarin and the newer anticoagulants make small bleeds more likely and more visible. Other causes: occasionally a bleeding tendency, certain eye infections, after eye surgery or an injection, and in newborns from the pressure of delivery. How long it lasts and what to expect A subconjunctival haemorrhage clears by itself. Over roughly one to two weeks (sometimes up to three for a large one) the body reabsorbs the blood, and just like a bruise on the skin it changes colour — from bright red to orange and yellowish — before disappearing completely with no mark and no effect on the eye. You do not need to do anything to make it heal, and there is no drop that clears it faster. When a red eye is NOT a simple blood spot The one thing that matters is separating a harmless blood spot from a red eye that needs a doctor. Seek prompt eye care — the warning signs on our emergency eye care page — if the red eye comes with any of these: Pain, light sensitivity or any change in vision (a true blood spot has none of these); A significant injury or blow to the eye — here the redness can hide a more serious problem inside the eye that must be examined the same day; Discharge, stickiness or grittiness, which point to infection or another surface problem rather than a simple bleed; Blood that looks like it is inside the coloured part of the eye (a different problem called a hyphema) after trauma; Both eyes together, or spontaneous bruising and bleeding elsewhere on the body. Blood spots that keep coming back A single blood spot in an otherwise well person needs no tests. But recurrent subconjunctival haemorrhages deserve a short look for an underlying reason — most often blood pressure, and a review of any blood-thinning medication. A quick blood-pressure check and, where relevant, a check for diabetes or a bleeding tendency usually settles the question; recurrent surface fragility can also relate to systemic vascular health, which is one reason a diabetic eye and general eye assessment is worthwhile if spots keep appearing. Two rules matter here: do not ignore repeated bleeds, and never stop a prescribed blood thinner on your own — any change is a decision for the doctor who prescribed it. Blood spots in newborns and after eye procedures A red patch on a newborn’s eye, present soon after birth, is common and comes from the pressure of delivery; it clears over one to two weeks like any other blood spot. Similarly, a little visible blood on the white after cataract surgery, an injection or an eye examination is expected and harmless. As always, pain, discharge or a change in the baby’s eye or general wellbeing should be reviewed promptly rather than assumed to be a simple bleed. How we assess it Diagnosis is usually made in seconds at the slit-lamp:

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