A hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris). The blood may cover most or all of the iris and the pupil, blocking vision partially or completely.
A hyphema is usually painful. If left untreated, it can cause permanent vision problems.
A hyphema is usually caused by trauma to the eye and is accompanied by an increase in intraocular pressure (the pressure inside the eye). However, it may appear without warning in children who have other medical conditions such as sickle cell anemia or hemophilia.
Immediate medical attention is needed if a hyphema occurs. The best way to prevent hyphema is to wear eye protection when playing sports. Also, never take an eye injury lightly. Even if there is no bleeding, you should check with your eye doctor.
The symptoms of a hyphema are relatively simple. They include:
- visible blood in the front of the eye
- sensitivity to light
- blurry, clouded, or blocked vision
- blood might not be visible if the hyphema is small
Your doctor will first want to get a complete medical history to see if you recently suffered eye trauma or if you have any other conditions that could lead to bleeding in your eye. After conducting a physical exam of the eye area, your doctor will use one of the following methods to diagnose a hyphema:
- comprehensive eye exam to test your ability to see
- eye pressure check
- examination of inside of eye with a special microscope called the slit lamp
- a CT scan might be ordered to check for fracture of the orbit (socket) if there was trauma to the eye
The most common cause of hyphema is eye trauma, usually received by a sports injury or a home/workplace accident or fall. A hyphema can also be caused by:
- abnormal blood vessels on the surface of the iris (colored part of the eye)
- eye infection caused by herpes virus
- blood clotting problems such as hemophilia and sickle cell anemia
- intraocular lens problems (artificial lens implants)
- cancer of the eye
If your hyphema is mild, it can heal on its own in about one week. You can treat any pain you experience with over-the-counter pain medication that does not contain aspirin. Aspirin should be avoided because it thins the blood, and that could increase your bleeding. Your doctor will decide how to treat your hyphema based on a variety of factors including:
- your age, overall health, and medical history
- extent of the injury
- your tolerance for specific medications
- personal opinion or preference
Once your doctor has collected this information, he or she will then be able to choose among the following treatments:
- eye drops (steroid drops to limit inflammation and/or dilating drops to help with pain)
- patch over the affected eye
- bed rest
- limited eye movement (this means no reading)
- head elevated at least 40 degrees when sleeping (to help body absorb blood)
- check eye pressure daily
One of the most serious complications associated with a hyphema is an increase in eye pressure. If a hyphema results in dangerously high eye pressure, your doctor may operate to remove excess blood. The threshold for lowering intraocular pressure will be lower for someone with sickle cell disease.
Pressure in the eye builds up because of blood from the hyphema can clog the eye’s drainage canal. This in turn can lead to the kind of long-term damage associated with glaucoma. Glaucoma is a life-long condition that will require more serious treatment. Your doctor will normally examine your drainage canal by doing a gonioscopy to see if any long-term damage has occurred and decide on any follow-up treatment.