Hyphema (Bleeding in Eye)

What Is a Hyphema?

Injuries can cause bleeding in the front (or anterior chamber) of your eye, between the cornea and the iris. This bleeding is called a hyphema.

This part of your eye holds a clear liquid called aqueous humor. Folds in the back (or posterior chamber) of your eye called ciliary processes make this fluid. It then passes through your pupil into the anterior chamber.

Hyphema Symptoms

Symptoms of a hyphema include:

  • Pain
  • Blurry, cloudy, or blocked vision, or vision with a red tint
  • Blood in the front of your eye
  • Sensitivity to light

When to go to the doctor

Hyphema is a medical emergency. Call your eye doctor right away. If they’re not available, go to your local hospital’s ER.

 

 

Hyphema Causes and Risk Factors

About 70% of hyphemas happen in children, especially in males ages 10 to 20. They’re usually caused by blunt injuries from activities like:

  • Sports
  • Industrial accidents
  • Falls
  • Fights
  • Shooting BB and airsoft guns

Less common causes include:

  • Eye surgery
  • Unusual blood vessels on your iris
  • Eye infections from a herpes virus
  • Blood clotting problems
  • Eye cancers

Some things that affect your blood can make you more likely to have a hyphema, such as:

  • Leukemia
  • Hemophilia
  • Sickle cell disease
  • Von Willebrand disease
  • Blood-thinning (anticoagulant) drugs

Hyphema Diagnosis

Your doctor will ask whether you’ve ever had an eye injury and what happened before the hyphema. It’s important for them to know if, for example, you were hit in the eye with a baseball or you ran into a tree branch.

The doctor will do an eye exam. This involves:

  • A visual acuity test to check how well you can see. They’ll also check the pressure inside your eye (called intraocular pressure).
  • Looking inside your eye with a special microscope called a slit lamp. A hyphema looks like a clot or layered blood in the front of your eye. If the anterior chamber is filled with blood, it’s called a total, black, or eight-ball hyphema. The doctor can also see if you have a microhyphema, which looks like a haze of red blood cells.
  • A CT scan to look at your eye sockets and other parts of your face, if the injury is severe
  • Screening for sickle cell disease or thalassemia in people of African descent

Questions to ask your doctor

  • How big is the hyphema?
  • Are there any signs of permanent damage?
  • Are there any signs of permanent vision loss?
  • How can I keep this injury from happening again?
  • Should I stop taking blood-thinning medications?
  • When can I get back to my regular activities?

 

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Hyphema Treatment

Don’t try to treat a hyphema without talking to your eye doctor. Don’t put anything over your eye, because you may do more harm than good.

Medical treatment

About 15% to 20% of people with a hyphema have more bleeding in 3 to 5 days.

Your body usually absorbs the blood, but your doctor will want to be sure that it’s happening like it should. If the pressure in your eye goes up or if you have more bleeding, you may need to stay in the hospital.

It’s important to follow your treatment plan. This usually includes:

  • Limit eye movement. Rest in bed with the head of the bed raised as far as you can.
  • Use eye drops exactly as prescribed. Your doctor will probably give you atropine to dilate (widen) your pupil and corticosteroids to prevent scarring.
  • Protect your eye. Cover it with a shield to keep from injuring it more. You may also need to wear a patch over the shield to keep light out of your eye.
  • Watch your medications. Don’t take any medicines with aspirin. It can lead to more bleeding. Also avoid nonsteroidal medications such as naproxenibuprofen, and many arthritis drugs. You can use a mild pain reliever, such as acetaminophen, but don’t take too much. You need to know if you have eye pain. It may be related to an increase in pressure. If the pain gets worse, go back to the doctor right away.
  • Check your pressure. Your doctor will probably want to measure the pressure inside your eye every day for several days.

You may also get medicine to prevent vomiting, which can raise the pressure inside your eye.

Red blood cells that block the mesh inside your eye can sometimes raise the pressure. If your eye pressure goes up, your doctor might give you medicine such as a beta-blocker.

Children and older people may not be able to follow the home treatment plan. They and people who have complications could need to stay in the hospital.

Depending on your case and your other medical conditions, you might need surgery.

Follow-up care

If you’ve been in the hospital for a hyphema, wear an eye shield for 2 weeks. You’ll need more eye exams for at least 2 to 4 weeks. Also, avoid difficult activities for at least 2 weeks.

 

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Hyphema Complications

A serious eye injury can raise your risk of glaucoma. Your doctor should check for it every year.

Other complications of a hyphema include:

  • Damage to your optic nerve
  • A stained cornea
  • Permanent vision loss

 

Hyphema Prevention

A hyphema can happen any time you injure your eye. Wear protective goggles when you take part in a sport or activity that could lead to eye injury.

WebMD Medical Reference Reviewed by Whitney Seltman on June 15, 2020

Sources

 

SOURCES:
American Academy of Ophthalmology: “Hyphema.”

StatPearls: “Hyphema.”

Medscape: “Hyphema.”

Merck Manual Consumer Version: “Hyphema.”

UpToDate: “Traumatic hyphema: Management.”

 

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