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Johns Hopkins Symptoms and Remedies

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Hyphema

What is it?

Hyphema is a visible accumulation of blood in front of the iris (the colored portion of the eye), usually resulting from an injury. While the outer most layers or whites of the eyeball contain capillaries (small blood vessels), the internal chambers of the eye contain no blood vessels. Instead, the eye has its own special circulatory system, consisting of a transparent liquid known as aqueous humor. If a capillary over the iris bursts, blood may seep into the aqueous humor and cause visual problems.

Fortunately, aqueous humor flows constantly across the iris and is reabsorbed by a network of small veins that empty into the bloodstream. The blood from a hyphema is usually carried away from the eye by the flow of the aqueous humor within a matter of days, and vision returns to normal.

However, a blood clot may block the small veins responsible for reabsorbing the aqueous humor, causing pressure to build up in the eyeball. This may result in damage to the optic nerve from glaucoma, a sight-threatening increase in pressure within the eye (see Glaucoma for more information). Similarly, damage from the injury that caused the hyphema may lead to glaucoma. The risk of glaucoma is greater with larger hyphemas or in cases when, after the blood has disappeared, there is subsequent bleeding and recurrence of hyphema.

What Causes It?

  • An injury to the eye, with a blunt object such as a ball or a fist, or by a puncture, is the most common cause of hyphema.
  • Severe inflammation of the iris may lead to hyphema.
  • A blood vessel abnormality may cause blood to leak into the front portion of the eye.

Prevention

  • Take care to avoid accidents involving the eyes.
  • Be sure to wear protective eyewear when playing racquet sports.

Diagnosis

  • Patient history and eye examination are needed.
  • A thorough eye examination is performed by an ophthalmologist if injury has occurred or if inflammation or blood vessel abnormality is a suspected cause.

How to Treat It

  • Bed rest and hospitalization may be required to allow damaged blood vessels in the eye to heal and to check for further bleeding and glaucoma. Administration of eyedrops that prevent movement of damaged blood vessels in the eye make the eye extremely sensitive to light. A shield or patch may be placed over the eye during recuperation. Sometimes, a clot-stabilizing drug, aminocaproic acid, is used to reduce further bleeding.
  • To prevent glaucoma, your ophthalmologist may prescribe eyedrops, such as timolol and acetazolamide, which reduce pressure inside the eyeball, or hyperosmotic agents (which draw fluid away from the inside of the eye), such as mannitol, glycerol, or sorbitol.
  • Surgery may be required to evacuate blood from the eye in severe cases. The ophthalmologist will create a small temporary opening, or drain, in the eye, so that the bloody aqueous fluid may be drawn out. This drain may be surgically reopened if hyphema recurs.

When to Call a Doctor

  • Call an ophthalmologist immediately if you injure your eye and hyphema is suspected, or if hyphema recurs after treatment.