What Is Subconjunctival Hemorrhage in Newborns and Why Does It Happen?

When you first look at your newborn and notice a bright red patch on the white of their eye, it can be alarming. This condition, called subconjunctival hemorrhage, is one of the most common findings after birth, affecting nearly half of all babies delivered vaginally. Despite its dramatic appearance, it’s almost always harmless and temporary.

A subconjunctival hemorrhage occurs when tiny blood vessels beneath the conjunctiva (the clear membrane covering the white part of the eye) rupture during delivery. The pressure changes that happen as your baby moves through the birth canal cause these delicate vessels to break, allowing blood to pool beneath the conjunctiva. The result is a vivid red patch that looks concerning but causes no pain or vision problems.

Think of it like a bruise on the eye’s surface. Just as a bruise on your skin gradually fades as your body reabsorbs the blood, a subconjunctival hemorrhage clears up on its own within a few weeks.

How Common Is Subconjunctival Hemorrhage After Birth?

The numbers might surprise you. Research shows that subconjunctival hemorrhage is remarkably common in newborns:

• Up to 46% of vaginally delivered babies develop this condition
• About 7% of cesarean-delivered babies show signs of subconjunctival hemorrhage
• Approximately 75% of vacuum-assisted deliveries result in this finding
• Forceps deliveries also carry increased risk compared to unassisted vaginal births

The dramatic difference between vaginal and cesarean delivery rates tells us something important: the physical pressures of moving through the birth canal are the primary cause. Babies born via cesarean section don’t experience the same compression forces, which explains why they’re far less likely to develop these hemorrhages.

It’s worth noting that researchers haven’t found meaningful connections between subconjunctival hemorrhage and factors like maternal age, baby’s size, or most other pregnancy-related variables. The method of delivery and any instruments used during birth are the main predictors.

What Does Subconjunctival Hemorrhage Look Like in a Newborn?

You’ll recognize a subconjunctival hemorrhage immediately. The condition has very distinctive characteristics that make it easy to identify:

• A bright red or bloodshot patch on the white part of the eye (sclera)
• Sharp, clear borders where the red area meets the normal white tissue
• No swelling, discharge, or cloudiness in or around the eye
• The baby shows no signs of discomfort or pain in the affected eye
• Normal pupil appearance and eye movement

The hemorrhage can be small, covering just a portion of the white of the eye, or it can be extensive, making the entire visible sclera appear red. Sometimes it affects one eye, sometimes both. Regardless of size, the appearance doesn’t correlate with severity because even large subconjunctival hemorrhages resolve without complications.

Your baby won’t cry more, avoid light, or show any behavioral changes related to the hemorrhage. Their vision remains completely normal throughout the healing process.

How Doctors Diagnose Subconjunctival Hemorrhage

Diagnosis is typically straightforward and happens through visual examination alone. When your pediatrician or nurse examines your newborn’s eyes in the hospital or at the first checkup, they can identify a subconjunctival hemorrhage immediately based on its characteristic appearance.

In most cases, no additional testing is needed. The condition is so common and benign that healthcare providers recognize it instantly and can reassure you on the spot.

However, there are specific situations where your doctor might recommend further evaluation:

• Both eyes are affected (bilateral hemorrhage), which may warrant checking for retinal hemorrhage
• The hemorrhage appears alongside other unusual findings during the newborn examination
• There are concerns about bleeding disorders based on family history or other symptoms
• The appearance seems atypical or doesn’t match the standard presentation

If your doctor does recommend an ophthalmology consultation, it’s usually precautionary. They want to ensure there’s no accompanying retinal hemorrhage, which can occur in some births but also typically resolves without treatment.

Does Subconjunctival Hemorrhage Require Any Treatment?

Here’s the good news: subconjunctival hemorrhage requires absolutely no treatment. Your baby’s body will naturally reabsorb the blood beneath the conjunctiva, just as it would heal a bruise anywhere else.

The typical timeline for complete resolution is:

• Most cases clear up within two weeks after birth
• Some may take up to three weeks to disappear completely
• No medications, eye drops, or interventions speed up this process
• The hemorrhage gradually fades from bright red to yellow-brown before disappearing

You don’t need to do anything special during this healing period. No eye drops, no warm compresses, no restrictions on bathing your baby or caring for their eyes normally. The condition resolves at its own pace regardless of any interventions.

Your primary role is simply monitoring the eye to ensure the red patch is gradually shrinking and fading rather than growing or changing in unexpected ways. If you notice any changes that concern you, a quick call or visit to your pediatrician can provide reassurance.

When Should You Contact Your Pediatrician About Your Baby’s Eye?

While subconjunctival hemorrhage is benign and self-resolving, there are certain situations where you should reach out to your baby’s doctor:

• The red patch is getting larger instead of gradually fading
• New redness appears after the initial hemorrhage seemed to be healing
• Your baby develops eye discharge, swelling, or cloudiness that wasn’t present before
• The hemorrhage hasn’t improved at all after three weeks
• Your baby seems to have trouble tracking objects or responding to visual stimuli
• You notice any other changes in your baby’s eyes or vision

These situations don’t necessarily indicate a problem, but they warrant professional evaluation to rule out other conditions that might require attention.

Remember that complications from subconjunctival hemorrhage are extremely rare. The vast majority of cases follow the expected pattern of gradual improvement and complete resolution without any lasting effects.

Can Subconjunctival Hemorrhage Affect Your Baby’s Vision?

This is often the biggest concern for parents, and the answer is reassuring: subconjunctival hemorrhage does not affect vision. The blood accumulates between two layers of tissue on the eye’s surface, nowhere near the structures responsible for sight.

The conjunctiva (where the bleeding occurs) is simply a thin, protective membrane covering the white part of the eye. The cornea, lens, retina, and other vision-critical structures remain completely uninvolved and unaffected by the hemorrhage.

Your baby can see normally from birth, and the presence of a subconjunctival hemorrhage doesn’t change that. There’s no need to worry about long-term vision problems, developmental delays related to sight, or any permanent effects from this condition.

Even extensive hemorrhages that make the entire white of the eye appear red don’t impair vision. The dramatic appearance doesn’t reflect the actual severity, which in all cases is minimal.

What Is Retinal Hemorrhage and How Is It Different?

While discussing subconjunctival hemorrhage, it’s worth understanding retinal hemorrhage since the two conditions can occur together. Unlike subconjunctival hemorrhage, retinal hemorrhage involves bleeding inside the eye, affecting the retina itself.

Retinal hemorrhages are also common after birth, though less visible than subconjunctival hemorrhages because they occur inside the eye rather than on its surface. They can only be detected through specialized eye examination with an ophthalmoscope.

Key differences between the two conditions:

• Subconjunctival hemorrhage is visible as a red patch on the eye’s surface; retinal hemorrhage is not visible without special equipment
• Subconjunctival hemorrhage never affects vision; retinal hemorrhage rarely affects vision but requires monitoring
• Both conditions typically resolve on their own within weeks to months
• Subconjunctival hemorrhage needs no follow-up in most cases; retinal hemorrhage may require ophthalmology evaluation

If your baby has bilateral (both eyes) subconjunctival hemorrhage, your pediatrician might check for accompanying retinal hemorrhage. This isn’t because there’s necessarily a problem, but because the two can occur together during difficult births, and retinal hemorrhage benefits from professional monitoring even though it usually resolves without complications.

Could Subconjunctival Hemorrhage Indicate Something More Serious?

In the overwhelming majority of cases, subconjunctival hemorrhage is simply a birth-related finding that carries no broader implications. However, doctors do consider other possibilities in certain specific circumstances.

If a subconjunctival hemorrhage appears atypical or recurrent, your pediatrician might consider:

• Bleeding or clotting disorders that affect how blood vessels heal
• Infection (though this typically comes with other symptoms like discharge or swelling)
• Trauma separate from the birth process itself

These alternative causes are rare in newborns, especially when the hemorrhage first appears right after birth and matches the typical presentation. Your baby’s doctor will use clinical judgment to determine whether any additional evaluation makes sense based on the complete picture of your baby’s health.

In older infants who weren’t just born, bilateral subconjunctival hemorrhages might prompt more careful evaluation to understand the cause, as birth-related pressure would no longer explain the finding.

Can You Prevent Subconjunctival Hemorrhage During Delivery?

The honest answer is that subconjunctival hemorrhage is largely unavoidable given the nature of birth itself. The physical process of moving through the birth canal creates pressure changes that can rupture these delicate blood vessels, and there’s no way to eliminate that pressure entirely while still allowing for vaginal delivery.

That said, the data does show some patterns:

• Cesarean delivery significantly reduces risk (7% vs. 46% for vaginal birth)
• Vacuum and forceps assistance increases likelihood (75% for vacuum-assisted deliveries)
• Careful instrument use during assisted delivery may help minimize occurrence

However, these aren’t practical prevention strategies. Cesarean sections carry their own risks and are reserved for medical indications, not to prevent benign conditions like subconjunctival hemorrhage. Similarly, when instruments like forceps or vacuum extractors are needed, they’re used because they’re medically necessary for a safe delivery.

The important perspective is this: subconjunctival hemorrhage is so benign that preventing it isn’t a medical goal. The focus during delivery appropriately remains on the health and safety of both mother and baby, not on avoiding minor, self-resolving findings that have no lasting impact.

Understanding the Difference Between Birth Injuries and Birth Trauma

When you hear “birth injury,” it’s natural to feel concerned. But medical professionals actually categorize findings like subconjunctival hemorrhage differently from injuries that require intervention or have lasting effects.

Subconjunctival hemorrhage falls into the category of expected birth-related findings rather than true injuries. It’s more accurately described as a consequence of normal birth processes rather than something that went wrong.

This distinction matters for several reasons:

• Hospitals don’t track or report subconjunctival hemorrhage as a birth injury or complication
• Public health data doesn’t include it among birth-related morbidities
• Insurance and medical records treat it as a normal finding rather than a complication
• No preventive measures or quality improvement initiatives target it because it’s not considered preventable or harmful

True birth injuries, in contrast, involve lasting effects or require medical intervention. They include conditions like brachial plexus injuries, skull fractures, or other trauma that needs treatment and follow-up.

Understanding this distinction can help frame your experience appropriately. Seeing a red patch on your newborn’s eye might be startling, but from a medical perspective, it’s in an entirely different category from injuries that cause concern.

What Happens During Healing

As the days pass after your baby’s birth, you’ll notice gradual changes in the appearance of the subconjunctival hemorrhage. Understanding what to expect can help you feel confident that healing is progressing normally.

First few days: The hemorrhage looks bright red and may seem quite prominent. This is completely normal. The blood under the conjunctiva is fresh, giving it that vivid appearance.

Week one: You might notice the edges of the red patch becoming less defined as your baby’s body begins reabsorbing the blood. The bright red color may start to shift slightly toward a darker or more brownish red.

Week two: The hemorrhage typically becomes noticeably smaller and may take on yellow or brownish tones as the blood breaks down. This color change is similar to what happens with a bruise on your skin and indicates normal healing.

Week three: Most hemorrhages have either completely resolved or are nearly gone by this point. Any remaining discoloration is usually faint and continues fading.

Throughout this process, you won’t need to do anything special. Normal bathing, handling, and care are all fine. The healing happens internally as your baby’s body naturally processes and removes the blood.

Living With Subconjunctival Hemorrhage

For the few weeks while the hemorrhage is visible, you might wonder about practical aspects of daily care. The good news is that subconjunctival hemorrhage doesn’t change anything about how you care for your newborn.

You can:

• Bathe your baby normally, including around the eyes
• Use gentle washcloths to clean their face without worry
• Take photos and enjoy these early days without medical concerns
• Go about all normal newborn activities without restrictions
• Bond with your baby through normal eye contact, which remains important for development

Some parents feel self-conscious about the appearance when introducing their baby to family and friends. If you want, you can simply explain that it’s a common, harmless condition from birth that will clear up soon. Most people who’ve been around newborns have seen it before.

The hemorrhage doesn’t cause your baby any discomfort, so there’s no reason to limit activities or handle them differently than you otherwise would.

Long-Term Outlook and Follow-Up Care

The long-term outlook for babies with subconjunctival hemorrhage is excellent because there is no long-term impact. Once the hemorrhage resolves, it’s truly over with no lingering effects.

Vision development proceeds normally. The hemorrhage doesn’t interfere with the critical visual development that happens during infancy. Your baby will meet all typical vision milestones on schedule.

No increased risk of future eye problems. Having a subconjunctival hemorrhage at birth doesn’t make your baby more likely to have eye issues later in childhood or adulthood.

No special follow-up needed. Beyond normal well-baby checkups where your pediatrician examines all aspects of your baby’s health, no additional eye appointments or monitoring are required for subconjunctival hemorrhage alone.

Standard vision screening applies. Your baby should receive the same vision screenings recommended for all children at regular checkups. The presence of a birth-related subconjunctival hemorrhage doesn’t change these recommendations.

In essence, after the hemorrhage clears, you can completely forget it ever happened. It leaves no mark, no scar, no lasting effect of any kind.

Finding Reliable Information and Support

In the age of internet searching, it’s easy to find yourself down a rabbit hole of concerning information when your baby has any medical finding. For subconjunctival hemorrhage specifically, remember that the medical consensus is clear and reassuring.

Trustworthy sources for information include:

• Your baby’s pediatrician, who can examine your specific situation and provide personalized guidance
• Medical databases like MedlinePlus and NIH resources, which provide evidence-based information
• Academic medical sources like StatPearls, which compile current research for healthcare professionals
• Hospital patient education materials, which are vetted by medical professionals

Be cautious of sources that:

• Suggest treatments or interventions (none are needed)
• Link subconjunctival hemorrhage to other serious conditions without context
• Provide anecdotes without medical backing
• Recommend unproven remedies or supplements

If you’re feeling anxious about your baby’s eye, reach out directly to your pediatrician rather than searching online. They can provide the reassurance and specific guidance you need based on seeing your baby in person.

Dealing With a Newborn’s Subconjunctival Hemorrhage

Discovering that your newborn has a bright red patch on their eye can be unsettling, but subconjunctival hemorrhage is one of those medical findings that looks more serious than it actually is. Nearly half of all babies born vaginally experience this condition, and it resolves completely on its own within a few weeks, leaving no lasting effects on vision or eye health. While the appearance might be dramatic, your baby feels no pain and can see perfectly normally throughout the healing process.

The key takeaway is that subconjunctival hemorrhage represents a normal consequence of birth rather than a true injury or complication requiring intervention. As your baby’s body naturally reabsorbs the blood beneath the conjunctiva over the coming weeks, you can focus on all the joys and challenges of welcoming your newborn without medical concern about their eye.