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

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

You 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 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 tell you to:

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

You may need surgery to help clear the blood from the front of the eye. You are more likely to need surgery if:

• the clot fills the entire front of the eye (called an eight-ball hyphema)
• you have sickle cell trait or sickle cell disease
• your 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)
• you bleed again

How long will the effects last?

• The risk for the eye bleeding again is highest in the first week after the bleeding started.
• 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.
• A hyphema caused by an injury to the eye can damage the eye, which may increase your risk for glaucoma.
• If the hyphema is not treated, it can damage your optic nerve and cause a permanent loss of vision.

How can I take care of myself?

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

How can I prevent hyphema?

• Always wear safety goggles or other eye protection when participating in sports.
• Wear seatbelts to decrease injuries from car accidents.