Waking up with red eyes can sometimes happen, but it can be concerning when it’s persistent. Blood inside the front of your eye (anterior chamber) is called a hyphema.
Hyphema can be a concerning condition that can result in long-term damage to your eyes. Fortunately, most hyphemas can be managed with careful and prompt care.
Learn more about hyphemas, their signs, and when to seek medical attention. Getting early treatment can help protect your vision.
How Does Hyphema Affect Your Eyes?
Hyphema causes blood to collect in the eye’s anterior chamber (the space in front of the iris and pupil). The blood lies in front of the iris and pupil and may obscure them.
It may also cover a partial area. In some cases of hyphema, you may temporarily suffer partial or complete vision loss.
Because hyphemas often occur due to an injury to the eye, you should seek immediate medical care. You could lose your eyesight in one eye if you don't receive medical attention.
Hyphema Grading System
Hyphemas can receive a grading between 0 to IV:
- Grade 0. No visible layering; however, you have red blood cells within the anterior chamber.
- Grade I. A layering of blood taking up less than one-third of the anterior chamber.
- Grade II. Blood has accumulated in between one-third and one-half of the anterior chamber.
- Grade III. Blood has collected in one-half to less than the total of the anterior chamber.
- Grade IV. Blood has entirely accumulated in the anterior chamber. A bright red color indicates total hyphema. However, a dark red or black appearance is called a blackball or 8-ball hyphema.
What are the Risk Factors of Hyphema?
Certain risk factors increase the likelihood of developing hyphema. These include:
- Engaging in contact sports
- Working in hazardous conditions that can affect the eyes
- Prior eye surgeries (due to more fragile blood vessels)
- Poor eye protection or not wearing safety goggles during high-risk activities
What are the Symptoms of a Hyphema?
Hyphema can make the front of your eye appear tea-colored or layered with blood. This is visibly distinct from a subconjunctival hemorrhage, which appears as a bright red patch on the surface of your eye.
Other symptoms include:
- Bleeding in the front of the eye
- Sensitivity to light
- Pain in the eye
- Blurry, clouded, or blocked vision
If you notice any of the signs or symptoms above, you should visit your local eye care clinic and speak with your doctor. A comprehensive eye examination will be necessary to provide proper care and lower the risk of any complications.
How is Hyphema Diagnosed?
If you believe you have a hyphema, visit your local eye clinic and speak to the ophthalmologist about any symptoms. During your visit, your doctor may do the following to diagnose hyphema:
- CT scan. Only ordered if orbital fracture, penetrating injury, or other facial trauma is suspected; this helps your doctor examine the bones forming the eye sockets and look for foreign bodies.
- Slit lamp examination. Your eye doctor may also perform a slit lamp examination of the eye’s anterior chamber to diagnose correctly.
- Pen-light examination. A pen-light can detect a layered hyphema in a seated patient but does not replace a slit-lamp exam for full assessment. This involves shining a light directly onto the eye to look for blood in the area.
How is Hyphema Treated?
Topical steroid drops may be used to calm inflammation and reduce the chance of adhesions inside the eye. Meanwhile, cycloplegic drops can relax the iris, reduce light sensitivity, and lower the risk of internal structures sticking together.
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But if your eye pressure is high, doctors usually recommend aqueous suppressants to lower intraocular pressure. These include:
- Beta-blockers
- Alpha-agonist
- Carbonic anhydrase inhibitors (CAIs)
In selected higher-risk cases, an antifibrinolytic (such as tranexamic acid or aminocaproic acid) may be used to reduce early rebleeding.
When is Surgery Necessary?
Most people heal without surgery, but a small minority need an anterior chamber washout to protect the cornea and optic nerve. During surgery, the ophthalmologist makes a tiny incision to irrigate and remove the blood.
Some signs you may need surgery include:
- Persistent large or total hyphema
- Corneal blood staining
- Dangerously high eye pressure (e.g., IOP >60 mm Hg for 48 hours, or IOP >25 mm Hg for several days)
Your surgeon may also act sooner if a total hyphema risks pupillary block or, in children, amblyopia. If pressure remains high, they may add procedures like a peripheral iridectomy (to prevent blockage) or a glaucoma drainage procedure.
Recovery And Follow-Up
You can expect a steady recovery within the first week, but there’s still a risk of rebleeding. The rebleed window peaks within two to five days, so follow-up is often daily during the first several days; the exact schedule varies by severity and risk.
Follow-up appointments will continue until your eye pressure is stable. Here are some things you should follow during recovery:
- Limit strenuous activity
- Sleep with your head elevated
- Use drops exactly as prescribed
Call your doctor right away for sudden pain, foggy or darkening vision, or a visibly rising fluid level in the front of the eye.
What to Do If You’re Waiting For Treatment
If you start experiencing hyphema symptoms, you might not be able to get treatment immediately. Fortunately, there are some things you can do while you wait to get urgent care:
- Avoid rubbing your eyes and use a protective eye shield if you have one.
- Keep your head elevated to about 30 to 45° to let the blood layer and settle.
- Avoid certain medications like aspirin or NSAIDs to prevent triggering a rebleed.
However, if you experience sudden vision loss, severe pain, or if the eye looks completely filled with blood, don’t wait. Seek medical care immediately.
What are the Possible Complications of Hyphema?
Some of the most common hyphema complications include:
- Prolonged elevated intraocular pressure (IOP).
- Optic nerve damage.
- Corneal bloodstaining, which can lead to decreased vision.
How to Prevent Hyphema
The best way to prevent hyphema is to protect your eyes from injury. Be sure to wear protective eyewear when participating in contact sports or hazardous work.
Goggles, safety glasses, and face shields can all help keep your eyes safe. Never drink alcohol while driving, as this can increase your risk of accidents and injuries to the face.
You should also be careful when handling tools or other sharp objects. Always use the appropriate protective gear and keep your hands away from your face. The same applies to other dangerous objects, such as firearms and explosives.
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