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Understanding Hyphema

Hyphema What is a hyphema?

Hyphema is a term used to describe bleeding in the anterior chamber (the space between the cornea and the iris) of the eye. By definition, hyphema simply means blood in the eye.

What causes hyphema?

Hyphema occurs when blood vessels in the iris bleed and leak into the clear aqueous fluid. There could be various causes of hyphema such as physical injury or trauma, high blood pressure, poor clotting ability, low platelet count or function, a tumor in the eye, retinal detachment, and other possible ocular or systemic conditions.

What are the symptoms of hypema (identifying hyphema)?

Patients with hyphema have a red hazy eye, which may or may not be painful, depending on the inciting cause. If both eyes are affected, the patient may seem blind or visually impaired. If hyphema is associated with trauma, there may be evidence of a corneal or periocular injury, or a history of trauma. If there is an underlying systemic condition that is associated with abnormal bleeding, then bruising may be noted in the oral cavity or on the abdomen. Decreased vision (Depending on the amount of blood in the eye, vision may be reduced to only hand movements and light perception only) and elevated intraocular pressure (in some cases) is also present in some cases.

How do you treat hyphema?

Treatment of hyphema depends on the underlying cause of the condition. Hyphema should not be treated at home without seeing your ophthalmologist. You should make no attempts to cover the eye, because, if done incorrectly, you may do more harm than good. Patients are often treated with topical and systemic anti-inflammatory medicines, and occasionally antibiotics.

Some patients also require an ocular ultrasound to evaluate the posterior portions of the eye. Additionally, surgery is sometimes recommended depending on the identified cause of hyphema. In some cases, a procedure is performed to irrigate the blood from the anterior chamber to prevent secondary complications such as glaucoma and blood stains on the cornea.

How do you diagnose hyphema?

It is very important for the doctor to determine the cause of the hyphema. If the hyphema is related to an ocular injury, any detail regarding the nature of the trauma is helpful. The doctor will assess visual acuity, measure intraocular pressure, and examine the eye with a slit lamp microscope and ophthalmoscope.

Is hyphema dangerous?

The answer to the question whether hyphema is dangerous or not depends on a number of factors. However, its outcome mainly depends upon the extent of injury to the eye. Patients with sickle cell disease have a greater likelihood of ocular complications and must be monitored more carefully. Severe vision loss can occur. It must also be remembered that many eye injuries can be prevented by wearing safety goggles or other protective eye wear. Always wear eye protection while playing sports such as racquetball, or contact sports such as basketball.

What happens if I don't do anything about it (possible complications?)

If the hyphema is left untreated for long, it could be even more dangerous and will lead to one or more of the following serious complications:

  • Recurring bleeding (About 15%-20% of people with a hyphema have further bleeding in 3-5 days)
  • Impaired vision through blood staining of the cornea
  • Glaucoma

I have blood on the white part of my eye. Is that hyphema?

A rupture of a blood vessel in the sclera (white part) of the eye will produce a "blood spot" and is not a hyphema. Instead, it is called as "subconjuctival hemorrhage". These can occur for various reasons such as high blood pressure, sneezing, rubbing, and coughing, vomiting or minor injury. However, they are fairly rare, and will likely resolve on their own. 

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