Hyphema · What Is It, Causes, Symptoms, and More

There are many causes of hyphema including trauma. Common sources include blunt force or penetrating injuries during sports like basketball, baseball, or hockey, and accidents involving paintballs, airsoft guns, or vehicle airbags.  

Alternatively, non-traumatic hyphemas can develop in individuals prone to bleeding without significant external force. These cases are often linked to underlying medical conditions such as diabetes mellitus, eye cancers (e.g., retinoblastoma, iris melanoma), clotting disorders (e.g., hemophilia, Von Willebrand disease), sickle cell disease or sickle cell trait, and the use of certain blood-thinning medications (e.g., warfarin). They may also occur due to vascular abnormalities in the iris or as a complication following cataract surgery. 

Diagnosing a hyphema involves a thorough review of medical history and a physical examination. The medical history may indicate recent eye trauma, vision changes, foreign body sensations, or increased light sensitivity. An ophthalmologist typically conducts a comprehensive eye exam, which includes inspection of the eyelids, lashes, lacrimal ducts, and the cornea for signs of hyphema; evaluation of visual acuity, often using a Snellen chart; and examination of pupil size and reaction to light using a penlight.  

A definitive hyphema diagnosis requires visible blood in the front of the eye, in the anterior chamber, detected through direct observation or a slit-lamp exam. Direct ophthalmoscopy or a slit lamp exam provides a detailed view of the anterior eye structures and lens. Before performing any pressure-inducing examinations like eyelid retraction or intraocular pressure measurement, it's critical to rule out an open globe injury, which is a full-thickness wound of the eye wall. Since corneal abrasion often accompanies hyphemas, fluorescein staining can be performed once an open globe injury is excluded.  

The treatment of hyphema involves both preventative measures and medical intervention. Protective eyewear can be worn during sports and high-risk activities like airsoft or paintball to reduce the risk of sports-related traumatic hyphemas. Those affected can wear an eye shield over the injured eye, removing the cover only for medical assessments. To help with recovery, the individual can rest in a low-lit, calm environment and limit eye movement for at least one week. One can also reduce the amount of reading done to reduce stress on the damaged blood vessels. Individuals can elevate the head to about 30 degrees, even while sleeping, to help with blood drainage while maintaining proper blood flow to the eye. Topical anesthetics like proparacaine or tetracaine, or dilating eye drops such as cyclopentolate or scopolamine, may relieve pain.  

One should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, as they can worsen the bleeding and also discontinue any offending medications that may have contributed to hyphema development (e.g., anticoagulants). In cases where the hyphema is large (i.e., occupying 50 percent or more of the anterior chamber) and doesn't resolve with rest and medication, or if the eye pressure continues to be elevated, surgical intervention to remove the blood may become necessary.