Hyphema (Bleeding in Eye)

Hyphema (Bleeding in Eye) Overview

Trauma to the eye can cause bleeding in the front (or anterior chamber) of the eye between the cornea and the iris. This “inside the eye” bleeding contained in the anterior chamber of the eye is called a hyphema.

The anterior chamber of the eye normally contains a clear liquid fluid called aqueous humor. The aqueous humor is secreted by the ciliary processes in the posterior chamber of the eye. The aqueous humor passes through the pupil into the anterior chamber.
 

Hyphema Causes

Blunt trauma to the eye is the usual cause of a hyphema. Additional bleeding may follow in the next 3-5 days even without additional trauma. This injury is usually blunt or closed trauma with typical causes, including athletic injury from a flying object, a stick, a ball, or another player's elbow. Other causes include industrial accidents, falls, and fights.

 

Hyphema Symptoms

A person with a hyphema may have had a recent incident of eye trauma, might feel pain in the injured eye, and may have blurred vision.

If the hyphema is large, the eye itself may look as if it is filled with blood. Smaller hyphemas are not readily visible to the naked eye.

When to Seek Medical Care

Hyphema is a medical emergency. Call your ophthalmologist (a medical doctor who specializes in eye care and surgery) for an immediate appointment. If you cannot contact your ophthalmologist, go to a hospital's emergency department.

Questions to Ask the Doctor

  • What is the size of the hyphema?

  • Are there any signs of permanent damage to the eye?

  • Are there any signs of permanent vision loss?

  • How can I prevent this injury from happening again?

  • When may I resume my regular activities?

Exams and Tests

Your ophthalmologist asks about any history of eye injury, when the injury may have happened, and how it happened. It is important for your ophthalmologist to know if, for example, you were hit in the eye with a baseball or you ran into a low-hanging branch on a tree.

 

A complete eye examination is performed.

  • A visual acuity test checks for how well you can see. The intraocular pressure (pressure inside the eye) must be checked.
  • A special microscope, called a slit lamp, is used to look inside the structures of the eye.
  • A hyphema can be seen as a clot or layered blood in the anterior chamber of the eye. The condition called "eight ball" or "black hyphema" occurs when the entire anterior chamber is filled with blood. Smaller hyphemas may appear layered in the anterior chamber.
  • A microhyphema may also be seen. This appears as a haziness of suspended red blood cells in the anterior chamber.
  • If you have experienced severe trauma, the doctor may order a CT scan to look at the eye sockets themselves and other facial structures.
  • African-Americans and those of Mediterranean descent should be screened for sickle cell disease or thalassemia, which can lead to serious complications. In these cases, surgery may be considered an early option.

 

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Hyphema Treatment - Self-Care at Home

Hyphema should not be treated at home without seeing your ophthalmologist. Make no attempts to cover the eye, because, if done incorrectly, you may do more harm than good.

Medical Treatment

Treatment of hyphema depends on how readily you comply with instructions. Following directions for care is important. About 15-20% of people with a hyphema have further bleeding in 3-5 days. This is why compliance with care is so important.

Blood usually reabsorbs, but the doctor must make sure the process is resolving as expected. If intraocular pressure increases or if bleeding reoccurs, you may be hospitalized.

  • You will be instructed to do the following as part of home follow-up care:

    • Rest in bed with the head of the bed elevated as much as you can tolerate.

    • Do not engage in any strenuous activity.

    • Do not take any medicines containing aspirin. It promotes bleeding. This also includes nonsteroidal medications, such as naproxen (Aleve), ibuprofen (Motrin), or many other arthritis medications.

    • You may take a mild pain reliever, such as acetaminophen (Tylenol), but do not take too much. You want to know if eye pain occurs, because it may be related to an increase in pressure in the eye. If eye pain increases, return to the doctor immediately.

    • Place drops in your eye 3-4 times a day or exactly as prescribed by your doctor. Drops of 1% atropine may be prescribed.

    • Cover the eye with a shield to protect it from further injury.

    • If you have a microhyphema or a small, layered hyphema, you might be asked to see your ophthalmologist every day for 5 days and then a week after that. A 1-month follow-up appointment may also be required. Your ophthalmologist checks your vision, intraocular pressure, and anterior chamber of the eye.
  • Children and elderly persons may not be able to follow the home treatment plan. They and others who have complications may be admitted to the hospital for close observation. Treatment is similar to that suggested for home follow-up care.

    • Medicine may be given to prevent you from vomiting; such activity that involves straining increases pressure in the eye.

    • If eye pressure increases, certain medicine, such as a beta-blocker, may be delivered through eyedrops into the eye. An occasional increase in pressure can be caused by the red blood cells obstructing the meshwork of the eye. When the meshwork is obstructed, the normal flow of liquid through the eye is interrupted. This increase of fluid in the eye increases the pressure in the eye.

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Next Steps - Follow-up

Someone who has been in the hospital for hyphema should wear an eye shield for 2 weeks following the trauma to the eye. You will need additional, extensive eye examinations for at least 2-4 weeks.

Also, avoid strenuous activities for 2 weeks.

Every year, you should be checked for the development of glaucoma. Any significant eye trauma can damage the eye's drainage system and put someone who has had a hyphema at risk for glaucoma.

Prevention

Hyphema can occur with any trauma to the eye. Wear protective eyewear whenever you play a sport that recommends it.

For More Information

American Academy of Ophthalmology
655 Beach Street
Box 7424
San Francisco, CA 94120
(415) 561-8500

Web Links

American Academy of Ophthalmology

 

Synonyms and Keywords

microhyphema, bleeding in the eye, eight ball, black hyphema, black eye

WebMD Medical Reference from eMedicineHealth Reviewed by Alan Kozarsky, MD on April 26, 2016

Sources

Authors and Editors

Author: John Sheppard, Jr., MD, MMSc, PhD, Program and Laboratory Director, Professor, Departments of Ophthalmology and Pharmacology, Eastern Virginia School of Medicine.

Editors: Richard W. Allinson, MD, Associate Professor, Division of Ophthalmology, Texas A&M University Health Science Center, Associate Professor, Department of Surgery, Scott and White Clinic; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Robert H. Graham, MD, Ophthalmologist, Robert H. Graham, MD, PC; Affiliated With Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona and Carl T. Hayden VA Medical Center, Phoenix, Arizona.

Hyphema (Bleeding in Eye) from eMedicineHealth.

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