Subconjunctival Haemorrhage in a Patient on Aspirin – PLAB 2 Response

Ann Augustin
Jun 12
2 min read

Updated: Nov 13

❓ "In case of subconjunctival haemorrhage, my patient is on aspirin. Do I ask them to stop taking aspirin, or should I prescribe something else?"

This is a great question – and one that tests both your clinical reasoning and your ability to apply judgment in a real-world scenario.

✅ Answer: No, you do not routinely stop aspirin.

A subconjunctival haemorrhage is usually a benign, self-limiting condition. It presents as a bright red patch on the white of the eye, caused by bleeding under the conjunctiva. Most cases are spontaneous, painless, and resolve on their own within 1–2 weeks without treatment.

In patients who are taking aspirin (or any antiplatelet therapy), you do not stop the medication unless there is a compelling reason to do so.

📌 Here's Why:

Aspirin might slightly increase the risk of recurrence or delay healing, but the bleeding is minor and not dangerous.
If aspirin is being used for secondary prevention of cardiovascular events (e.g. heart attack, stroke), stopping it can cause more harm than benefit.
The haemorrhage itself does not threaten vision and usually doesn't require medical treatment.

🔍 What Should You Do Instead?

Reassure the patient that the red patch is harmless and will resolve spontaneously.
Do not prescribe any eye drops or medications unless there are other ocular findings.
Avoid stopping aspirin unless advised by a senior or if part of a wider bleeding concern.
Consider further workup if:
- The haemorrhage is recurrent
- There is a history of easy bruising or other unexplained bleeding
- The patient is on warfarin or DOACs – in such cases, check INR or relevant labs

🗨️ How to Explain It to the Patient:

“This red area in your eye is due to a small burst blood vessel under the surface. It’s not serious and will go away on its own in about one to two weeks. Since you’re on aspirin, it may have contributed, but we usually continue aspirin because stopping it could put you at risk of serious problems like a heart attack or stroke. We’ll keep an eye on things, and if this keeps happening, we may do some blood tests just to be safe.”

📚 References