Hyphema is when red blood cells collect around the eye’s anterior chamber. The anterior chamber is the area between the cornea (a clear, curve-shaped window at the front of the eye) and the iris (the colored part of the eye).
The hyphema may extend to all of the iris and pupil (the circular, dark area in the middle of the eye). However, 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.
People with a history of eye trauma or recent ocular surgery face a higher risk of developing a hyphema.
Hyphema Grading System
Hyphemas can receive a grading between I-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 to 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. If the anterior chamber is filled with bright red blood, eye care specialists will call it a total hyphema. If the blood takes on a dark red-black color, eye care specialists will call it a blackball or 8-ball hyphema.
What Causes Hyphema?
There can be two main causes of hyphema: blunt eye trauma or conditions that cause increased bleeding states.
Blunt Eye Trauma
In many cases, a person develops a hyphema because of blunt eye trauma or open globe injury. This injury causes a tear of the eye’s iris or pupil and allows blood to accumulate.
Possible causes of blunt trauma may include:
- Sports injuries
- Car accidents
- Assault
- Falling or hitting something with the eye area
Increased Bleeding States
You may develop a hyphema due to an underlying health condition or certain medications that increase eye bleeding.
The following list includes diseases or drugs that increase the risk of a hyphema:
- Rubeosis iridis (may be secondary to diabetic complications)
- Juvenile xanthogranuloma
- Iris melanoma
- Myotonic dystrophy
- Keratouveitis (e.g., secondary to herpes zoster)
- Leukemia
- Hemophilia
- Von Willebrand disease (VWD)
- Any substance that affects platelet or thrombin function (e.g., ethanol, aspirin, and warfarin)
Finally, you may also develop a hyphema after undergoing ocular surgery, such as placing an artificial lens in the eye during cataract surgery.
Hyphema vs. Subconjunctival Hemorrhage
In some cases, you may mistake a broken blood vessel for a hyphema. However, a broken blood vessel is a common subconjunctival hemorrhage that will not cause pain.
A hyphema can cause eye pain and permanent vision issues and requires proper treatment.
Here are a few differences between the two:
| Hyphema | Subconjunctival Hemorrhage | |
| Location | Anterior chamber (between cornea and iris) | Between conjunctiva and sclera |
| Cause | Trauma (blunt/penetrating) or medical conditions | Minor trauma, strain, systemic diseases (such as high blood pressure) |
| Symptoms | Pain, blurred vision, sensitivity to light | Painless, bright red patch |
| Vision Impact | Can lead to vision impairment | No impact on vision |
| Management | Rest, protection, eye drops, possible surgery | Self-resolving, cold compresses |
Signs & Symptoms of Hyphema
Hyphema can cause a range of symptoms and signs. If you have a hyphema, you may experience the following symptoms and signs, including:
- 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.
One study reported hyphema due to eye trauma occurred in every 12 of 100,000 people; 70% of these cases were in children.1
Can Hyphema be a Sign of Something Serious?
Yes, hyphemas may be a sign of something more serious. It’s important to seek medical care if you believe you have a hyphema.
When you undergo an eye examination, your eye doctor will grade your hyphema according to height and color. Color will vary according to how long you have had the hyphema.
If the hyphema is darker in appearance, the blood has already clotted.
When is Hyphema an Emergency?
A hyphema can become an emergency when a person doesn’t receive proper treatment, and vision loss worsens. The hyphema can become more severe when a person does not receive medical care and has elevated intraocular pressure.
Increased intraocular pressure raises the risk of further complications, including partial or total vision loss. Always treat hyphema as a medical emergency to prevent complications.
How to Manage Hyphema Symptoms
If you have a hyphema, there are steps that you can take to lessen symptoms. You can follow the recommendations listed below:
- Wear an eye shield. It's important to wear eye shields if your doctor has prescribed one. This will keep the eye protected from further injury.
- Sleep with your head in an elevated position. This helps the red blood cells separate and move away from the line of sight.
- Avoid air travel until your eye has healed. The changes in air pressure could heighten the pain and impact your eye.
- Take the medications prescribed by your eye care specialist. If there is a problem, you should call your clinic.
- Don’t take aspirin or other anti-inflammatory medication. Medicines like ibuprofen or naproxen could increase bleeding if you take them without consulting your doctor beforehand.
- Avoid touching your eye. Always wash your hands before touching your eye and avoid rubbing the injured eye. Rubbing can make the problem worse.
- Contact lens and eye makeup restrain. Don’t wear contact lenses or put on eye makeup until your eye has fully recovered and your doctor gives you approval.
- Rest your eyes. Limit reading and other activities that require a lot of eye movement within the first 24-48 hours of the hyphema.
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. This helps your doctor examine the bones forming eye sockets and other facial areas.
- 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 examination may be enough for people with a large hyphema. This involves shining a light directly onto the eye to look for blood in the area.
Risk Factors of Hyphema
Certain risk factors increase the likelihood of developing hyphema. These include:
Participating in Contact Sports
People who participate in sports activities are at risk of hyphemas, especially if they do not wear protective eyewear. Small balls like racquetballs are an example of sports items that could result in serious eye problems.
Occupational Hazards
Those working in construction sites or manufacturing are more likely to get hyphema. This is because they’re more prone to accidents that affect the eyes at their workplace.
Prior Eye Surgeries
In some cases, people with previous eye surgeries can develop hyphema. Your condition may make your blood vessels more fragile.
Poor Eye Protection
Poor eye protection may also increase your likelihood of getting hyphema. You’re more likely to get hyphema if you don’t wear protective eyewear or safety goggles while doing high-risk activities.
Possible Complications of Hyphema
The outlook for a person who suffers from hyphema depends on several factors, including the severity and location of the injury.
Some of the most common hyphema complications include:
- Prolonged elevated intraocular pressure (IOP). This is when the blood buildup leads to elevated eye pressure. Eye care specialists will grade hyphemas to understand the extent of the risk present for IOP elevation.
- Optic nerve damage. The elevated intraocular pressure can lead to optic nerve damage and may possibly result in vision loss.
- Corneal bloodstaining. Bleeding in the anterior can result in corneal bloodstaining and lead to decreased vision.
What Treatment Options Are Available for Hyphema?
Your treatment options will vary according to the cause of the hyphema and severity grading. Here are some possible treatment options for hyphema:
General Treatment Recommendations
Your eye doctor may ask you to do the following:
- Wear a special eye shield for protection
- Reduce physical activities or rest at home
- Elevate your head (at least 45 degrees) to help with drainage and intraocular pressure
Medications
You may also receive prescribed eye drops to reduce swelling inside the eye and minimize pain or discomfort.
However, your eye doctor will tell you not to use aspirin or other anti-inflammatory medications to avoid worsening your hyphema.
Hospitalization
Finally, hospitalization may be necessary for specific patient profiles, including:
- Non-compliant patients
- Those with bleeding diathesis (a tendency to suffer from a bleeding condition) or blood dyscrasia (an abnormal condition or disease of the blood)
- Those with severe ocular or orbital injuries
- Those with known sickle cell disease and increased intraocular pressure
An estimated 5% to 7.2% of patients with traumatic hyphema will require surgery.8
Follow-Up Care
Patients with a history of eye trauma will require follow-up care with a gonioscopic examination. This series of patients risk developing angle-recession glaucoma (extra fluid build-up could damage the optic nerve).
It is important to maintain follow-up visits, as intraocular pressure may increase and put you at risk of glaucoma (damage of the optic nerve) or corneal damage.
How to Prevent Hyphema
While recovering from hyphema is possible, it’s always best to avoid it first. To prevent future incidents of hyphema from blunt eye trauma, you should take these steps:
Wear Protective Eyewear
You should always wear protective eyewear when participating in contact sports or high-risk activities. It helps to protect your eyes from any potential injury. Goggles, safety glasses, and face shields can all help keep your eyes safe.
Never Drive While Intoxicated
Driving while intoxicated increases the risk of accidents and injuries. Have a designated driver or opt for ride-sharing apps instead. In addition, always wear your seat belt when inside a moving vehicle.
Be Careful When Handling Sharp Objects
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.
Summary
- Hyphema is a condition involving blood collection in the eye’s anterior chamber.
- Blunt eye trauma or medical conditions such as sickle cell disease can cause this condition
- Treatment options vary depending on the cause and severity of the hyphema
- Limiting your activities that could potentially cause eye injury can help prevent hyphema in the future
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