Red, sticky & watery eyes

A bright red patch on the white of your child's eye

One morning the white of your child's eye has a patch of solid red on it, sharp-edged, as if someone spilled a drop of paint. It looks like the most serious thing you have seen all year. Almost always, it is the least serious thing in this list.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Practises at Hospital Kuala Lumpur 12 min read · 2,201 words

Key takeaways

A subconjunctival haemorrhage is blood pooling just under the clear surface of the eye, not bleeding inside the eye itself. It does not affect sight.
It is not usually painful. A red patch that also hurts, or comes with blurred vision, is a different picture and needs a same-day look.
In children, a knock, a fall, or vigorous eye rubbing is a common cause. Coughing fits, vomiting and straining can also do it by raising pressure in the veins for a moment.
It is common in newborns after a vaginal birth, from pressure during delivery, and settles on its own like any other patch.
The patch fades over one to two weeks on its own, changing colour like a bruise as it goes. Nothing you put in the eye speeds this up.

The white of your child's eye has a patch of solid red on it, sharp at the edges, as if a drop of paint had landed there overnight. It looks like the most serious thing you have seen on your child all year. It is usually one of the least serious, and here is why, what usually causes it at every age, and the short list of situations where it is not that simple.

What is that red patch on the white of my child's eye?

It is almost certainly a subconjunctival haemorrhage: a small blood vessel just under the clear surface layer of the eye has burst, and the blood has pooled in that thin layer rather than gone anywhere near the inside of the eye. The surface layer, the conjunctiva, sits on top of the white of the eye the way cling film sits on a bowl. When a vessel underneath it leaks, the blood has nowhere to go but to spread flat under that layer, which is exactly why the patch looks so vivid and so sharply outlined against the white around it.

What makes it alarming is how it looks, not what it is. A bruise on the arm goes through the same shades of red and yellow-green as it heals, but skin is thick and a little dull, so we barely notice the colour underneath it. The white of the eye is thin, pale and constantly on display, so the same ordinary process is lit up like nothing else on the body.

Does it hurt, and will it affect my child's vision?

No, on both counts, and this is the detail that tells us the most. A straightforward subconjunctival haemorrhage causes no pain, no light sensitivity and no change to how well your child sees, because the bleeding sits on the surface, outside the parts of the eye that do the actual work of seeing. Most children do not even notice it is there until someone points it out or they catch sight of it in a mirror.

That is also the quickest way to tell this apart from something that needs urgent attention. A red eye that is genuinely painful, that comes with blurred or reduced vision, or that makes your child squint against light, is telling a different story. Everything below assumes an eye that otherwise looks and behaves completely normally, just with a patch of red on it.

What usually causes this in an older baby or child?

A knock is one of the most common reasons, more often than parents expect. A ball to the face, a fall against a table corner, a poke from a sibling's finger or a toy, or vigorous rubbing after something got in the eye can all burst a small vessel on the surface without doing any lasting damage. If you remember a clear bump or a hard rub just before the patch appeared, that is very likely your answer, and a minor knock of the kind covered in the ordinary bumps and knocks that happen at home is usually followed by nothing more than exactly this kind of patch.

Anything that suddenly raises the pressure in the veins of the head and neck for a moment can do the same thing without any contact at all: a hard coughing fit, forceful vomiting, sneezing, straining on the toilet, or a long bout of crying. None of these need to be dramatic. An ordinary stomach bug with a few rounds of vomiting, or a chesty cough that goes on for a week, is often enough on its own.

Sometimes there is simply no cause we can find, and that is a normal outcome of a proper check, not a gap in it. If your child rubs their eyes often enough to worry you, rather than as a one-off after a cough, it is worth asking why they keep doing it.

Why does my newborn have a red patch after birth?

Because of pressure during a vaginal delivery, and it is genuinely common: in one study, roughly one in eleven newborns had a subconjunctival haemorrhage. As your baby's head and shoulders pass through the birth canal, the pressure on the head and neck rises for a short time, and that pressure can burst a small vessel on the eye's surface in exactly the same way a hard coughing fit can later in life. On its own, this is not a sign that anything went wrong during the birth.

The newborn patch behaves the same way it does at any other age: it needs no treatment, does not bother the baby, and fades over one to two weeks. What matters, as at every age, is the eye around it. A newborn's eye that is otherwise white, moving normally and comfortable, with a red patch simply sitting there, is the reassuring picture. Anything else about the eye at this age is worth mentioning to your paediatrician at the same visit, rather than waiting.

How long will it take to go away, and what actually helps?

Most patches fade over one to two weeks, and I cannot give you a firmer number than that, because it genuinely depends on how large the patch is and how quickly your child's own body reabsorbs it. Expect it to change colour as it goes, the same way a bruise does: bright red at first, settling to a darker red, and finally a yellowish tinge before it disappears completely. It is normal for it to look slightly larger over the first day or two before it starts to improve, which can be the most worrying stage to watch, even though it is entirely expected.

Nothing you put in the eye speeds this up. No drop, ointment or home remedy makes the blood clear any faster. If the eye feels a little dry or gritty while it fades, plain lubricating eye drops can ease that, but they treat dryness, not the redness itself. There is usually no need to keep your child home for it.

When is a red patch not that simple?

A short list of things change the picture, and each one is worth a same-day look rather than waiting to see if it settles.

The first is pain, blurred vision, or light sensitivity alongside the redness, because a straightforward patch causes none of these. The second is a clear injury: if the patch followed an actual blow, poke or scratch to the eye, especially if the eye itself now looks swollen, waters constantly, or is hard to open, that needs assessment on the same day, since a knock hard enough to burst a vessel can occasionally mark the eye itself too. The third is a feverish, swollen or tender eyelid alongside the redness, pointing toward an eyelid or eye infection rather than a simple haemorrhage. If that is what you are seeing, a swollen eyelid has its own set of urgent signs worth knowing.

The fourth is a patch that keeps recurring with no obvious trigger, or that turns up alongside unexplained bruising or bleeding elsewhere on your child's body. Neither is common, and neither means something is necessarily wrong, but both are worth a proper look rather than a guess, because occasionally they point to something affecting how the blood clots, which is found by asking questions and, if needed, a simple blood test.

The last is a baby or toddler with a red patch that has no clear explanation, appearing together with any other bruise or injury. I want to say this calmly, because it is not an accusation and it should never feel like one: this particular combination, an unexplained mark plus another injury, in a child too young to explain what happened, is exactly the kind of picture doctors are trained to think carefully about and rule things out on. Bringing your child in for that review is the responsible thing to do, not a sign that anyone has assumed anything about you.

What should I tell the doctor if I do bring my child in?

Say when you first noticed it, and whether anything happened just beforehand: a cough, a fall, vomiting, or nothing you can recall. Mention whether your child seems bothered by it, whether their vision seems different, and whether this has happened before. If your child has ever had unusual bruising or bleeding, or takes any regular medication, say so. A photograph taken on the day you noticed it is genuinely useful, since these patches fade and change colour quickly, and a doctor seeing it a week later benefits from knowing what it looked like at the start.

See a doctor the same day if…

The patch followed a clear knock, poke or blow to the eye, especially if anything else about the eye looks different.
The eye is painful, the eyelids are swollen and red, or your child has a fever alongside the redness.
Vision seems blurred or changed, or the patch keeps recurring without an obvious reason.
There is unexplained bruising or bleeding anywhere else on your child's body at the same time.
A baby or toddler has a red patch with no clear cause, alongside any other injury: this deserves a calm, careful check, not because anyone is assumed to have done anything wrong, but because it is exactly the kind of combination a doctor is trained to rule things out on.

Common questions

Is a red patch on my child's eye the same as pink eye?

No, and telling them apart matters. A subconjunctival haemorrhage is a sharp-edged patch of solid red with an otherwise white, comfortable eye. Pink eye (conjunctivitis) makes the whole eye look pink or bloodshot, often with discharge, grittiness or watering. If you are not sure which you are looking at, my article on pink eye in children walks through the difference in more detail.

Will the redness spread or get worse?

It may look slightly bigger over the first day or two before it starts to fade, which can be unsettling to watch, but that is part of the normal course rather than a sign it is worsening. It then changes colour over one to two weeks, much like a bruise does, moving from bright red to a darker red and finally a yellowish tinge before it is gone.

Does it hurt my child, and will it affect their eyesight?

A straightforward subconjunctival haemorrhage does not cause pain and does not affect vision, because the bleeding sits in a thin layer on top of the eye rather than inside it. If your child is genuinely uncomfortable, keeps rubbing that eye because it stings, or seems to be seeing less clearly, that points to something other than a simple patch, and is worth a same-day look.

My newborn has a red patch in one eye. Is this from the birth?

Very possibly, and it is common. Pressure on the head and neck while passing through the birth canal can burst a small vessel on the surface of the eye, and in one study, roughly one in eleven newborns had this after a vaginal birth. It settles on its own over one to two weeks, exactly like it does at any other age, and on its own it is not a sign anything went wrong during delivery.

What should I do to make it go away faster?

Nothing, and that is the honest answer. No eye drops, ointment or home remedy speeds up how quickly the blood is reabsorbed. If the eye feels a little dry or gritty while it fades, plain lubricating eye drops (artificial tears) can help with that discomfort, but they will not shorten how long the patch itself takes to clear.

My child keeps getting these patches. Should that worry me?

A patch here and there with an obvious cause, a coughing fit, a hard rub, a bump, usually is not a pattern worth chasing. Repeated patches with no clear trigger are different, and are worth mentioning to your doctor, because they can occasionally point to something affecting how the blood clots or the vessels themselves, which is found by asking questions and, if needed, a simple blood test rather than by looking at the eye alone.

Could this be a sign of high blood pressure?

In adults, yes, it is one of the things doctors check for, particularly if the patches keep coming back. In an otherwise well child it is a much less common cause, but if your child has a medical condition that affects blood pressure or blood clotting, or takes a medicine that thins the blood, mention the patch to whoever manages that condition rather than assuming it is unrelated.

Is a red patch after eye rubbing something to worry about?

On its own, no. Vigorous rubbing is one of the ordinary ways a small vessel on the surface of the eye can burst, alongside a coughing fit, vomiting, or straining. If the rubbing itself has become frequent and hard enough to worry you, it is worth a look at why your child keeps rubbing their eyes, since that habit sometimes has its own explanation worth finding.

References

StatPearls (NCBI Bookshelf) · Subconjunctival Hemorrhage · www.ncbi.nlm.nih.gov
Guy's and St Thomas' NHS Foundation Trust · Sub-conjunctival haemorrhage · www.guysandstthomas.nhs.uk
Pediatric Education · How common are subconjunctival hemorrhages in newborns and infants? · pediatriceducation.org
American Academy of Ophthalmology · What is a subconjunctival hemorrhage? · www.aao.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.