• Hyphema

    (Blood in the Eye)

    Definition

    Hyphema is the collection of blood in the front portion of the eye. The blood collects between the clear dome of the eye (cornea) and the colored part of the eye (iris). Sometimes the blood can cause a buildup in pressure which can damage the eye.
    Normal Anatomy of the Eye
    IMAGE
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    Causes

    Hyphema is caused by a tear in the iris or nearby structures that lead to bleeding. The damage is most often caused during trauma to the eye. The damage may also be caused by certain medical conditions.
    In some cases, the cause may be unknown.

    Risk Factors

    Hyphema caused by trauma is more common in males. Factors that may increase the chances of hyphema due to trauma include:
    • A car or pedestrian accident
    • Playing sports that puts the eyes at risk, such as racquetball
    • Using power tools without proper eye protection
    Medical conditions that may increase the risk of hyphema include:
    • Eye diseases, such as glaucoma or anterior uveitis
    • Eye infections
    • Complications from eye surgery
    • Blood disorders, such as leukemia, hemophilia, or thrombocytopenia
    • Medications that make it harder for the blood to clot, such as aspirin or warfarin
    • Structural abnormalities, such as the abnormal growth of blood vessels
    • Cancerous tumors (rare)

    Symptoms

    Blood will be visible in front of part or all of the colored part of the eye. Other symptoms may include:
    • Change in quality of vision
    • Blurred vision
    • Pain
    • Sensitivity to light
    • Nausea or vomiting

    Diagnosis

    The doctor will ask about any possible injury to the eye and your medical history. An exam of the eye and surrounding structures will be done to look for other injuries, such as a fracture in the bones around the eyes.
    Tests may include:
    • Blood tests to check blood clotting time
    • CT scan to assess the eye and nearby structures

    Treatment

    The goal of treatment is to help the body clear the blood out of the eye and monitor pressure in the eye. In most cases, hyphema will resolve on its own. If the bleeding was due to a medical condition, it may require separate treatment.
    Certain activities such as lifting, straining, or hard exercise can worsen bleeding or restart bleeding. These activities will be limited during recovery. Head elevation while lying down will also help drain blood out of the eye.
    Medications, including steroids and pupil-dilating eye drops, may help ease discomfort and inflammation. Other anti-inflammatory medications, such as ibuprofen or naproxen, can make bleeding worse and should be avoided. Over the counter medication acetaminophen is a safe options to help manage discomfort since it will not encourage bleeding.
    The eye will need to be monitored to make sure the pressure is not increasing. Most can recover at home with follow up visits to the doctor. Severe hyphema, those with high pressure, may need to be monitored at a hospital. Increasing pain or worsening vision during the recovery phase is not normal and requires emergency attention.
    Surgery
    High pressure can lead to permanent damage of the cornea or the development of glaucoma. If the pressure inside the eye increases too much or blood is not clearing as expected, a surgery may be needed. The surgery will:
    • Relieve internal eye pressure and help open clogged drainage channels
    • Remove any excess fluid or blood

    Prevention

    Hyphema is usually caused by trauma. To help reduce the chance of hyphema, wear appropriate eye protection when playing sports, using power tools, or anytime the eye will be at risk for injury.

    RESOURCES

    American Academy of Ophthalmology http://www.aao.org

    National Eye Institute https://nei.nih.gov

    CANADIAN RESOURCES

    Canadian Ophthalmological Society http://www.cos-sco.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Eye contusions and lacerations. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/injuries-poisoning/eye-trauma/eye-contusions-and-lacerations. Updated October 2014. Accessed May 23, 2016.

    Hyphema—emergency management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Accessed May 23, 2016.

    Paracentesis. Boston University School of Medicine Department of Ophthalmology website. Available at: http://www.bu.edu/eye/phacoprimer/paracentesis. Accessed May 23, 2016.

    Pokhrel PK, Loftus SA. Ocular emergencies. Am Fam Physician. 2007;76(6):829-836.

    What is hyphema? American Academy of Ophthalmology website. Available at: http://www.aao.org/eye-health/diseases/what-is-hyphema. Updated March 1, 2016. Accessed May 23, 2016.

    Revision Information

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