retina surgery - Retina Specialist | Eye Diseases | Eye Care

Subconjunctival Hemorrhage; "Complication" of Vitrectomy?

A subconjunctival hemorrhage is quite frightening, but when following vitrectomy, it is quite benign.

Similar to a Bruise

A bruise of your skin and a subconjunctival hemorrhage are the same thing. In both cases, blood is trapped beneath tissue. The difference is that with the eye hemorrhage, the blood is trapped underneath very thin transparent tissue.

Hence, the bright red appearance. There is no muscle or skin to mask the bright red color.

Causes of a Subconjunctival Hemorrhage

There are many causes of a subconjunctival hemorrhage. The blood itself is benign, painless yet ugly. The cause of the hemorrhage could be from an infection, inadvertent poke in the eye, cough/sneeze/strain, etc. On rare occasion the bleeding could be a sign of systemic disease, hence, your doctor must be made aware of frequent or bilateral subconjunctival hemorrhages.

Bleeding Caused by Surgery

The intent of this article was to address the bleeding following vitrectomy or scleral buckle retinal surgery.

The conjunctiva is a very thin and relatively clear tissue and is the outermost covering of the eye. It surrounds the beginning at the edge of the cornea.

The conjunctiva has lots of tiny blood vessels. These tiny vessels are quite fragile and can bleed easily. Many times I’ll use a cotton swab to push on the eye…it can bleed.

Most of the time, the bleeding is caused by directly poking or cutting through the fine delicate blood vessels of the conjunctiva as I am preparing the eye for surgery or as I am finishing up surgery.

While scary, it’s a frequent occurrence (I’m deliberately avoiding the word “complication”) and probably happens about 50% of the time.

It’s Scary, but Harmless

When related to surgery, it’s scary but harmless. So many patients get over excited by the gruesome look. It will go away, migrate with gravity and may even change color. A subconjunctival hemorrhage usually takes 1-2 weeks for the blood to go away.

Blood must be broken down then absorbed by the body. The by-products of the breaking down of blood can have different hues/colors/shades.

What Does This Mean?

A subconjunctival hemorrhage is benign. It has no relationship to whatever is going on inside the eye. Following surgery, it’s natural to get fixated on the appearance of the eye..that’ normal. Rest assured, however, that it is a frequent occurrence in retinal surgery.

A subconjunctival hemorrhage does not occur so often with cataract surgery. Modern cataract surgery requires incisions (cutting into the eye) through the cornea. The cornea is devoid of blood vessels.

If you are concerned about bleeding on the outside of your eye, you should alert your doctor.

Retina Surgery is "Same Day" Surgery

Retinal eye surgery, either vitrectomy or scleral buckle, is usually performed while the patient is awake and as an outpatient, allowing you to go home the “same day.” Usually, there is absolutely no pain with retina surgery and recovery takes place in the comfort of your own home.

In most cases, operations are performed under “local sedation.” This term varies, but at our surgical center local sedation involves giving a sedative through the intravenous (I.V.). This puts the patient in “la la land” for a few minutes during which the eye is then numbed using an injection. When the patient awakes, the eye is numb and can’t move.

Pain is transmitted via nerves. The anesthetic prevents the perception of pain by blocking nerve conduction. The nerves that control the eye muscles are also blocked, thus, the eye can not move. Both pain and movement are controlled.

The eye remains in the eye socket during the operation. The eye lids are held wide open with a wire clamp, or speculum, to allow maximum exposure of the eye for the surgery.

The time for surgery depends on the retinal procedure and the amount of work required, but the anesthesia will work for several hours.

Vitrectomy eye surgery involves minimal cutting on the eye. The use of 25-gauge instruments for vitrectomy eliminates cutting tissue on the outside of the eye, thus, there isn’t much discomfort any way. Scleral buckle surgery for retinal detachments creates the most discomfort due to increased cutting on the outside of the eye, but this method of anesthesia is still very effective.

Most of the time, my patients are completely awake…and comfortable. We can talk and listen to music. On occasion, patients will report they are able to see the instruments moving inside the eye!

On rare occasion general anesthesia is required. This may be due to the age of the patient (i.e. child), anxiety, claustrophobia, etc. We usually prefer the patient fully awake or slightly sedated. The recovery is much faster, easier and safer without general anesthesia.

What Does This Mean? In most cases, technology has improved retina surgery to be completed much faster, and safer, than even 10 years ago. The reduction in operating times, the time it requires to perform an operation, has allowed “local” anesthesia to become preferred by many doctors.

Along with shorter operating times, and less general anesthesia, most surgery is easily performed as an outpatient as the time it takes to recover from “anesthesia” is much shorter.

Many practices choose to operate in a surgical center, a freestanding outpatient surgical site, – usually maximizing efficiency…and time.