What Is Infant Subconjunctival Hemorrhage?
Subconjunctival hemorrhages in newborns occur when small blood vessels in the white of the eye (sclera) burst and cause a bleed.
The sclera is covered by a thin, clear layer of tissue called the bulbar conjunctiva. The blood that is trapped in the sclera cannot be wiped away or rinsed out. The result of this bleeding is a red patch covering part or most of the white of the eye, depending on the severity of the infant subconjunctival hemorrhage.
Most mild cases of subconjunctival hemorrhages in newborns cause minimal discomfort and will not interfere with a child’s vision. However, some severe or recurrent cases may cause permanent eye damage or point to a larger, undiagnosed issue.
Causes of Newborn Subconjunctival Hemorrhages
Most cases of subconjunctival hemorrhage in newborns are the result of birth trauma from sudden increases in internal or external pressure. This pressure is usually applied during birth and can come from a variety of sources.
Common causes of pressure resulting in infant subconjunctival hemorrhages include:
- Difficult or prolonged labor
- Fetal macrosomia (infant birth weight of 8 lbs. 13 oz. or higher)
- Misuse of forceps or vacuum extractors
Assistive delivery devices like forceps and vacuum extractors are particularly prone to causing birth injuries. Force applied carelessly by medical staff in the delivery room can have lifelong consequences for children.
Symptoms of Infant Subconjunctival Hemorrhage
The most common symptom of a subconjunctival hemorrhage in a baby is a distinctive red patch in the white of the eye. Variation in the shade or size of the red patch can indicate the level of severity, with larger or darker patches indicating a more intense bleed.
As the blood is reabsorbed into the skin, the affected area may turn yellow. This is a sign that the injury is healing — similar to a fading bruise — and is not a symptom of an infection or a cause for concern. The yellowing can occur evenly across the bleed or may first appear as an island that spreads slowly across the red.
In rare cases, there may be permanent eye damage or vision loss. A subconjunctival hemorrhage in babies may also be an early symptom or indication of a more serious problem, such as a bleeding disorder, tumor, or a more severe birth injury.
Diagnosing Subconjunctival Hemorrhages for Newborns
Diagnosis of infant subconjunctival hemorrhage is mostly visual. Neonatologists (newborn doctors) will perform eye exams while the infant is in the hospital after delivery.
They will visually examine the eyes for color changes indicating a subconjunctival hemorrhage. They will also perform an eye exam with an ophthalmoscope to examine how the light from the scope transmits through the eyes, where other eye disorders can be detected.
In certain cases, you may see redness right after delivery, while in others, you might see a gradual reddening in the first day of life. The red patches resulting from the bleeding are distinctive and relatively common. Doctors may choose to monitor the baby’s blood pressure if hypertension is a concern.
Further testing from an ophthalmologist to follow up may become necessary if the problem fails to resolve or reoccurs.
Treatment of Infant Subconjunctival Hemorrhage
There is no specific treatment for infant subconjunctival hemorrhage. Most cases clear up on their own within 2-3 weeks.
Doctors may prescribe eye drops to help with itchiness or discomfort as the blood is reabsorbed and the blood vessels heal. The baby may need to have their blood pressure regularly checked to ensure it is normal.
Is Newborn Subconjunctival Hemorrhage Preventable?
Some cases of infant subconjunctival hemorrhage are not preventable. During a difficult or intense labor, a large amount of pressure may be exerted naturally by strong contractions.
However, births using assistive delivery devices can cause infant subconjunctival hemorrhages — and can be prevented.
Excessive force can exert pressure on the child during delivery when forceps or vacuum extractors are used incorrectly, resulting in complications such as a subconjunctival hemorrhage in a baby.
Infant Subconjunctival Hemorrhage and Medical Negligence
Doctors owe their patients the best possible care, especially during stressful emergency situations. When quality care is not provided and mistakes are made, this low standard of care may be considered medical negligence.
If you or your family has been affected by medical negligence resulting in a birth injury such as an infant subconjunctival hemorrhage, you may be entitled to financial compensation.
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