Hemorrhagic chemosis


  • Not to be confused with standard subconjunctival hemorrhage
  • Sometimes referred to as subconjunctival hematoma or bloody chemosis
  • Results from the rupture of subconjunctival blood vessels, typically due to significant trauma

Clinical Features

Marked lid edema and subconjunctival hemorrhagic chemosis, with "black ball hyphema" in the right eye after direct trauma.
  • Normally associated with significant ocular trauma.
  • Painful (at rest or with eye movements)
  • May have change in visual acuity
  • Examination
    • Fresh raised hemorrhagic chemosis

Differential Diagnosis

The following are conditions that may appear similarly to hemorrhagic chemosis but have an alternate etiology:

  • Carotid-cavernous fistula
  • Cavernous venous thrombosis (can present with chemosis + proptosis)

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses



  • Check visual acuity
  • Visualize injury with slit lamp exam
  • Consult ophthalmology if available or consider transfer if not
  • Obtain orbital CT imaging
  • Once globe rupture is ruled out, continue with tonometry and fluoroscein exam.
  • Consider
    • Coagulation studies
    • Vessel imaging of the head if suspicion for CVT


While most cases of hemorrhagic chemosis occur following trauma, it is important to also consider whether the patient has an underlying coagulopathy or structural condition (ie. cavernous venous thrombosis) that would predispose them to this or a similarly appearing condition[1]. When assessing a patient with hemorrhagic chemosis, the following associated conditions should be considered:

  • Globe rupture
  • Scleral laceration
  • Penetrating foreign body


If globe rupture is suspected:

  • Consult ophthalmology if haven't already or transfer patient as this is an ophthalmologic emergency
  • Initiate broad spectrum antibiotics
  • Check tenatus vaccine status and administer if due
  • Consider placement eye shield as protective measure to avoid further damage


  • Ultimate disposition often depends on the associated ocular trauma for which hemorrhagic chemosis may be a sign.

See Also

External Links


  1. Pargament J, Corrêa ZM, Augsburger JJ. Ophthalmic trauma. In: Riordan-Eva P, Augsburger JJ, eds. Vaughan and Asbury’s General Ophthalmology. 19 ed. New York, NY: McGraw-Hill; 2018:380-389.