Hyphema
Hyphema is blood in the front area (anterior chamber) of the eye. The blood collects behind the cornea and in front of the iris.
The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.
Causes
Hyphema is most often caused by trauma to the eye. Other causes of bleeding in the front chamber of the eye include:
- Blood vessel abnormality
- Cancer of the eye
- Severe inflammation of the iris
- Advanced diabetes
- Blood disorders such as sickle cell anemia
Symptoms
Symptoms include:
- Bleeding in the anterior chamber of the eye
- Eye pain
- Light sensitivity
- Vision abnormalities
You may not be able to see a small hyphema when looking at your eye in the mirror. With a total hyphema, the collection of blood will block the view of the iris and pupil.
Exams and Tests
You may need the following tests and exams:
- Eye exam
- Intraocular pressure measurement (tonometry)
- Ultrasound testing
Treatment
Treatment may not be needed in mild cases. The blood is absorbed in a few days.
The outcome of the condition will likely be much worse if bleeding comes back or worsens, especially within 3 to 5 days. The health care provider may recommend the following to cut down the chance that there will be more bleeding:
- Bed rest
- Eye patching
- Sedating medicines
You may need to use eye drops to decrease the inflammation or lower the pressure in your eye.
The eye doctor may need to remove the blood surgically, especially if pressure in the eye is very high or the blood is slow to absorb again. You may need to stay in a hospital.
Outlook (Prognosis)
The outcome depends upon the amount of injury to the eye. People with sickle cell disease are more likely to have eye complications and must be watched closely. People with diabetes will probably need laser treatment for the problem.
Severe vision loss can occur.
Possible Complications
Complications may include:
- Acute glaucoma
- Impaired vision
- Recurring bleeding
When to Contact a Medical Professional
Call your provider if you notice blood in the front of the eye or if you have an eye injury. You will need to be examined and treated by an eye doctor right away, especially if you have decreased vision.
Prevention
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.
References
Lin TKY, Tingey DP, Shingleton BJ. Glaucoma associated with ocular trauma. In: Yanoff M, Duker JS, eds. Ophthalmology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 10.16.
Olitsky SE, Marsh JD. Injuries to the eye. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 653.
Patel S, Kim SJ, Sternberg P. Surgery for ocular trauma: principles and techniques of treatment. In: Sadda SVR, Sarraf D, Freund B et al, eds. Ryan's Retina. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 113.
Version Info
Last reviewed on: 11/10/2022
Reviewed by: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
