Blood in the Front of the Eye (Hyphema)

What is a hyphema?

A hyphema is a layered collection of blood in the front part of the eye. The blood can block light from reaching the back of the eye, or the pressure inside the eye can increase. Both of these can cause blurry vision.

What is the cause?

A hyphema is usually cause in one of two ways:

• Injury to the eye can cause bleeding from blood vessels of the iris (the colored part of the eye around the pupil). If there is enough blood to settle into layers in the front of the eye, it is called a hyphema.
• Abnormal blood vessels in the front of the eye can lead to sudden bleeding and hyphema. A number of medical problems can cause abnormal blood vessels, including diabetes, poor blood flow to the eye, and tumors.

What are the symptoms?

Symptoms of hyphema include:

• decreased vision
• pain or a feeling of pressure in the eye
• painful sensitivity to light
• redness of the eye

How is it diagnosed?

Your child’s healthcare provider will ask about symptoms, examine your child’s eyes, and do tests such as:

• an exam using a special microscope (a slit lamp) to look closely at the front of the eye
• an exam with drops and special lenses to look into the back of the eye (a dilated exam)
• measurement of the pressure inside the eye
• an ultrasound test to examine the back of the eye if the provider cannot see through the blood

Your child may be tested for sickle cell trait. People with sickle cell trait have an increased risk of elevated eye pressure and vision loss from hyphema.

How is it treated?

Call your child’s healthcare provider right away if you notice blood in the front of the eye. Sometimes, the blood may be absorbed in a few days. Often, your healthcare provider will advise that your child:

• avoid bending and strenuous activity
• rest in bed with his or her head elevated
• wear an eye shield to protect the eye
• use eye drops to decrease the inflammation or lower pressure in the eye

Your child may need surgery to help clear the blood from the front of the eye. This is more likely if:

• the clot fills the entire front of the eye (called an eight-ball hyphema)
• your child has sickle cell trait or sickle cell disease
• your child’s eye pressure stays high even with treatment
• the blood in the front of the eye starts to stain the cornea (the clear outer layer of the eye)
• your child bleeds again

If the eye does not bleed again, the hyphema will usually clear on its own in one or two weeks, depending on how much blood is present. If the hyphema is not treated, it can damage your child’s optic nerve and cause a permanent loss of vision.

How can I take care of my child?

Follow your healthcare provider's instructions for care. Keep all follow-up visits with your child’s healthcare provider. Your child may be at risk for other eye conditions because of the hyphema.

How can I prevent hyphema?

• Make sure that your child always wears goggles, safety glasses, or eye shields when playing sports where the eyes could be injured.
• Make sure that your child always wears seatbelts to decrease injuries from car accidents.