Hyphema

What is a Hyphema?

A hyphema is the presence of blood or red blood cells in the anterior chamber which is the fluid filled space between the cornea (the clear portion of the eye) and the iris (the color portion of the eye).

What Causes a Hyphema?

Eye Trauma

Trauma to the eye is the most common cause of a hyphema. Blunt trauma causes a compressive force to the eye. This can cause an injury to the iris, ciliary body, trabecular meshwork, and its blood vessels. The damage to the blood vessels allows blood to enter the anterior chamber.

Eye Surgery

A hyphema can occur during or after an eye operation. The incidence of this complication is related to the type of ocular surgery.

Laser Surgery

A hyphema from a laser procedure is most commonly secondary to a YAG laser peripheral iridotomy for narrow angle glaucoma. These are generally very mild and resolve very quickly.

Spontaneous Hyphema

A hyphema can develop secondary to numerous ocular diseases or conditions and may include:

Iris rubeosis

Iris melanoma

Uveitis

Blood disorders

Juvenile xanthogranuloma

Von Willebrand disease

Symptoms Related to Hyphema

The symptoms may vary depending on the etiology of the hyphema. Blurred vision, distorted vision, and red tinged vision are common complaints.

Clinical Signs and Diagnosis of Hyphema

The diagnosis is made with a slit lamp examination (microscope used to examine the eye) of the anterior portion of the eye with the finding of blood in the anterior chamber. If the hemorrhage is large enough, it can be seen with the naked eye.

The color of the blood and the amount of blood should be documented. The darker the blood the longer the hyphema has been present.

The size of the hyphema may be graded in I to IV levels of the degree of the amount of blood present in the eye.

Grade 1: Layered blood filling less than 1/3 of the anterior chamber

Grade 2: Layered blood filling 1/3 to ½ of the anterior chamber

Grade 3: Layered blood filling ½ to almost total filling of the anterior chamber

Grade 4: Totally filled anterior chamber

Medical Management of Hyphema

The typical hyphema is managed in a conservative manner with an eye shield, bed rest or limited activity, and elevation of the head. This can be done at home unless there are extenuating circumstances. The patient is followed at intervals to monitor the status of the eye as it heals.

Topical Medications

Topical cycloplegics to dilate and paralyze the iris muscles may be used.

Topical corticosteroids may be used to decrease any inflammation in the eye.

Medications may be needed to control the eye pressure if it becomes elevated from the hyphema.

Surgical Treatment of Hyphema

If the intraocular eye pressure cannot be controlled or the patient begins to develop other complications such as corneal blood staining or continuous rebleeding, a surgical treatment may be necessary.

Surgical intervention is usually the irrigation and aspiration of the blood from the anterior chamber.

Summary

The prognosis depends on the etiology of the cause of the hyphema. Most patients do well and maintain their vision after resolution of the hyphema. The patient should be monitored after the hyphema has resolved as they can develop glaucoma at a later date from damage to the trabecular meshwork (portion of the eye that drains the fluid from the eye) inside the eye.

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