What is Hyphema?

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If you develop a hyphema, it means that the front of your eye has collected blood. It occurs between two main areas of the eye: 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 cases of hyphema, you may suffer partial or complete loss of vision temporarily. Because hyphemas often occur due to an injury to the eye, you should seek immediate medical care. An eye care specialist will rule out any further injuries and minimize the risk of complications. 

If you do not receive medical attention, you could lose your eyesight in one eye. 

People who have a history of eye trauma or recent ocular surgery face a higher risk of developing a  hyphema. 

What Causes Hyphema?

In many cases, a person develops a hyphema because of an injury or blow to the eye. This injury causes a tear of the iris or pupil of the eye and allows blood to accumulate. 

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. 

Additionally, you may develop a hyphema due to an underlying health condition or certain medications. 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 (an enzyme that plays a role in blood clots and coagulation) 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. 

If you do develop a hyphema, your ophthalmologist will want to study your eye up close. Your eye care doctor will look at the following items:

  • How well you can see
  • The pressure in your eye
  • The inside of your eye

In some cases, you may mistake a broken blood vessel for a hyphema. However, a broken blood vessel is a subconjunctival hemorrhage that is common and will not cause pain. A hyphema can cause pain and permanent vision issues and requires proper treatment. 

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 that 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 is 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. Also, your eye doctor will consider intraocular pressure (IOP)

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. 

Eye care specialists will grade hyphemas to understand the extent of the risk present for IOP elevation. IOP will increase with larger hyphemas. An exception to the rule is those cases in which the person has sickle cell disease. Patients with sickle cell disease can have elevated IOP even with a low-grade hyphema.

Clotting disorders or sickle cell disease will place a person at risk of ocular complications, such as a hyphema. Sickle cell anemia is more common in people of African descent, reaching at least 10% of that demographic. 

When is Hyphema an Emergency?

A hyphema can become an emergency when a person does not receive proper treatment, and vision loss worsens. The hyphema can become more severe when a person does not receive medical care and elevate intraocular pressure. 

Increased intraocular pressure raises the risk of further complications, including partial or total vision loss. 

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 if your doctor tells you to do so. 
  • Try to sleep with your head in an elevated position. 
  • 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. 
  • Do not take aspirin or other anti-inflammatory medication like ibuprofen or naproxen without consulting your doctor beforehand. Medicines of this kind could increase bleeding. 
  • Wash your hands before touching your eye and avoid rubbing the injured eye. Rubbing can make the problem worse. 
  • Do not wear contact lenses or put on eye makeup until your eye has fully recovered and your doctor gives you approval. 
  • Limit reading and other activities that require a lot of eye movement within the first 24-48 hours of the hyphema. 

An estimated 5% of patients with traumatic hyphema will require surgery. 

How is Hyphema Diagnosed? 

If you believe that you have a hyphema, visit your local eye clinic and speak to the ophthalmologist about any symptoms. 

Your eye doctor may order a CT scan and examine the bones that form the eye sockets and other areas of the face. Your eye doctor may also perform a slit lamp examination of the eye’s anterior chamber to diagnose correctly. 

A pen-light examination may be enough for people with a large hyphema. 

What Treatment Options are Available for Hyphema?

Your treatment options will vary according to the cause of the hyphema and severity grading. 

Irrespectively, 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

Your eye doctor will tell you not to use aspirin or other anti-inflammatory medications to avoid worsening your hyphema. You may also receive prescribed eye drops to reduce swelling inside the eye and minimize pain or discomfort. 

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. 

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 

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).

Resources
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Gragg, James. “Hyphema.StatPearls [Internet]., U.S. National Library of Medicine, 22 July 2021.

Hyphema.Hyphema - American Association for Pediatric Ophthalmology and Strabismus.

Hyphema.Hyphema | Columbia Ophthalmology.

Hyphema: Care Instructions.MyHealth.Alberta.ca Government of Alberta Personal Health Portal.

Syed, Zeba A. “Hyphema.EyeWiki, 20 Mar. 2021.

Thiel, Bryan. “HYPHEMA.Moran CORE | Hyphema, John A. Moran Center - University of Utah Health Care.

Turbert, David. “What Is Hyphema?” American Academy of Ophthalmology, 19 May 2021.

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