A hyphema can cause discomfort, vision issues, and light sensitivity. In most cases, permanent damage does not occur, but it is possible.

Because of this, people should seek prompt treatment, which can range from medications and home methods to more extensive treatment for complications that arise.

A hyphema occurs when blood collects in the eye, which can lead to a blockage of vision. (Learn More)

Trauma is the usual cause of this condition. However, there are cases where it can happen without trauma when people have certain medical conditions.

This issue can be painful and cause vision issues, so it is important to seek prompt treatment. There is also the risk for serious complications if a hyphema is not treated. (Learn More)

There are several tests that the doctor might perform to make an accurate diagnosis. If trauma was the cause, it is also important to perform additional testing to look for other potential issues, such as a concussion. (Learn More)

Once someone has an accurate diagnosis of a hyphema, there are treatment options. (Learn More) The best treatment depends on several factors, such as the person’s age, how they tolerate medications, and the severity of their injury.

Due to the potential for complications, it is important for everyone to take the right preventative measures. A few simple things can help to reduce the risk of a hyphema for most people. (Learn More)

What Is a Hyphema?

A hyphema is characterized by blood pooling inside the eye at the front of it. The blood collects between the iris and the cornea. The iris is the part of the eye with color, and the cornea is the eye’s clear covering.

As the blood collects, it covers the pupil either partially or completely. The pupil is the black circle inside the iris. When a hyphema is present, people can experience a partial or total blockage of their vision.

An injury to the eye that results in the pupil or iris tearing is usually responsible for this condition. Other less common factors that may cause a hyphema include:

  • Abnormal surface blood vessels on the iris.
  • Blood clotting disorders.
  • Cancers of the eye (only in rare cases).
  • Herpes virus-related eye infections.
  • Artificial lens problems following cataract surgery.

It is important to note that a broken blood vessel is a separate issue referred to as subconjunctival hemorrhage. This hemorrhage is usually harmless and not painful. However, a hyphema usually causes pain.

Without prompt and proper treatment, a hyphema can lead to permanent vision issues. The symptoms of a hyphema may include:

  • Anterior eye bleeding.
  • Eye pain.
  • Sensitivity to light.
  • Cloudy vision.
  • Blocked vision.
  • Blurry vision.

There are different severity grades associated with a hyphema.

  • Grade 0: A microscope is necessary to see the red blood cells, but the blood pooling is not visible.
  • Grade 1: The pooled blood fills less than a third of the chamber.
  • Grade 2 The pooled blood fills up to half of the chamber.
  • Grade 3: The pooled blood fills more than half of the chamber, but not all of it.
  • Grade 4: The chamber fills completely with blood. It is called an 8-ball hyphema if the blood is dark red. It is called total hyphema if the blood is bright red.

woman suffering from ocular migraine

Possible Complications of a Hyphema

When a hyphema is present, there are certain complications that a person can experience. These may include:

  • Glaucoma. This condition is characterized by pressure in the eye increasing. If glaucoma is not treated, it can lead to blindness.
  • Eye structure damage. This condition can sometimes lead to corneal blood staining. In some cases, this can result in permanently cloudy vision.
  • Recurrent bleeding. It is possible for a hyphema to bleed again. This is more common with more severe cases.
  • Vision loss. It is important that a hyphema is viewed as an emergency and treated immediately. Without immediate treatment, vision loss is possible.

Getting a Diagnosis

A complete medical history is needed to make a diagnosis. It is important to determine if the person recently experienced any issues that could cause bleeding in the eye or trauma that affected the eye.

The doctor will physically examine the eye to look for a hyphema or any signs of trauma. To accurately diagnose this condition, there are certain tests the doctor might perform.

  • Comprehensive eye examination: This is performed to assess a person’s ability to see.
  • Eye pressure examination: Since a potential complication of a hyphema is an increase in eye pressure, this test is performed to see if the pressure is at an abnormal level.
  • CT scan: If trauma was the cause of the hyphema, the doctor may order a CT scan to determine if the eye socket is fractured.
  • Slit lamp test: This is done to get a better look inside the eye. It allows the doctor to use a combination of bright light and magnification so they can better assess the eye’s internal structures.

Treatment Options

There are different treatment options that can be used to treat a hyphema.

  • Protect the affected eye by wearing a special shield over it.
  • Help the eye drain by raising the head of the bed.
  • Rest and avoid physical activity for the specified amount of time.
  • See an ophthalmologist regularly, so they can assess eye pressure and healing.

If the person has swelling in the eye, the doctor might prescribe eye drops for this. They work to reduce discomfort and pain. These should be taken exactly as directed. If they are not helping with the pain, it is important to let the doctor know right away.

Avoid aspirin and other medications that can thin the blood for as long as the doctor advises. These medications could potentially worsen a hyphema by causing more bleeding in the eye.

man using eyedrop

If someone is taking blood thinners for another condition, they need to let the doctor know immediately. The doctor might adjust the dose temporarily to prevent a worsening of the hyphema.

In severe cases, the person might be hospitalized so their hyphema can be constantly monitored. This is typically reserved for cases where the hyphema is a grade 3 or higher. If someone has other eye conditions, such as pre-existing glaucoma, this might be necessary since a hyphema may further increase eye pressure.

Doctors will want to assess eye pressure often. If it becomes too high, treatment needs to be administered quickly to prevent glaucoma. Once glaucoma occurs, corneal damage is possible that could lead to permanent problems with the affected eye.

If glaucoma occurs, the doctor will prescribe treatments aimed at this condition. Treatments for glaucoma may include:

  • Eye drops. This is often the first treatment considered to reduce eye pressure. They help by promoting the drainage of fluid from the eye or reducing how much fluid the eye produces. These eye drops may include prostaglandins, alpha-adrenergic agonists, beta blockers, rho kinase inhibitors, carbonic anhydrase inhibitors, or cholinergic or miotic agents.
  • Oral medications. Doctors might prescribe a carbonic anhydrase inhibitor to further reduce eye pressure if eye drops are not reducing it enough.

If medications are not effective for reducing eye pressure, the doctor might recommend a surgical procedure to remove the accumulated blood or other excess fluid. These procedures may include:

  • Filtering surgery. This works by making an opening in the eye’s sclera. The doctor also takes away a portion of the eye’s trabecular meshwork.
  • Minimally invasive glaucoma surgery. This procedure reduces eye pressure. There are multiple techniques that doctors might consider.
  • Laser therapy. If the trabecular meshwork has any clogged channels, this surgery might be considered. The doctor uses a laser to open up any clogs. It can take up to a few weeks for the results to be apparent.
  • Drainage tubes. The doctor places a shunt. Any excess fluid is able to drain, so eye pressure reduces.

Hyphema Prevention

Any time there is trauma to the eye, a hyphema can occur. When playing contact sports or doing any activity where an eye injury could occur, it is imperative to wear protective eyewear and take the proper precautions to protect the eyes from impact.

A hyphema is a condition that should be treated promptly. It could happen to anyone, so using preventative measures is imperative.

Due to the risk of complications, if anyone suspects they have a hyphema, they should consult a doctor to get an accurate diagnosis.

References

What Is Hyphema? American Academy of Ophthalmology.

What Causes Hyphema? American Academy of Ophthalmology.

Hyphema. All About Vision.

Hyphema Is Blood in the Eye. Verywell Health.

What Is a Slit Lamp? American Academy of Ophthalmology.

Glaucoma. Mayo Clinic.