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Blunt trauma to the eye can cause bleeding in the front (or anterior chamber) of the eye between the cornea and the iris. This bleeding into the anterior chamber of the eye is called a hyphema. The anterior chamber of the eye 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. The aqueous humor provides important nutrition to the inner structures of the eye.

Complications of Hyphema

Complications of Hyphema are secondary conditions, symptoms, or other disorders that are caused by Hyphema. In many cases the distinction between symptoms of Hyphema and complications of Hyphema is unclear or arbitrary.

Causes of Hyphema

Trauma to the eye may initially cause a small hyphema. More severe bleeding may follow in three to five days. This trauma is usually blunt or closed trauma, and it may be the result of an athletic injury from a flying object, a stick, a ball, or another player's elbow. Other causes include industrial accidents, falls, and fights.

Signs & Symptoms of Hyphema

  • 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. Extremely large hyphemas filling the entire anterior chamber appear dark red and have been called "eight ball" hyphemas.

Diagnosis of Hyphema

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 in the anterior chamber consisting 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 bones forming 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.

Treatments of Hyphema

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 three to five 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 anti-inflammatory 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 three to four times a day or exactly as prescribed by your doctor. Drops of 1% atropine may be prescribed. Steroid drops may also be prescribed to fight inflammation and pain.
  • 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 five days and then a week after that. A one-month follow-up appointment may also be required. At these visits, the ophthalmologist checks your vision, intraocular pressure, and the anterior chamber of the eye.
  • Children and elderly people 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 backup of fluid in the eye increases the pressure in the eye.

Prevention of Hyphema

Hyphema can occur with any trauma to the eye. Wear protective eyewear whenever you play a sport that recommends it. Industrial environments may also be hazardous, thereby necessitating mandatory eye protection.

When to seek Medical Advice

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.

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