Definition

Hyphema is blood in the front area (anterior chamber) of the eye. The blood collects behind the cornea and in front of the iris.

Causes

Hyphema is most often caused by trauma to the eye. Other causes of bleeding in the front chamber of the eye include:

• Blood vessel abnormality
• Cancer of the eye
• Severe inflammation of the iris
• Advanced diabetes
• Blood disorders such as sickle cell anemia

Symptoms

Symptoms include:

• Bleeding in the anterior chamber of the eye
• Eye pain
• Light sensitivity
• Vision abnormalities

You may not be able to see a small hyphema when looking at your eye in the mirror. With a total hyphema, the collection of blood will block the view of the iris and pupil.

Exams and Tests

You may need the following tests and exams:

• Eye exam
• Intraocular pressure measurement (tonometry)
• Ultrasound testing

Treatment

Treatment may not be needed in mild cases. The blood is absorbed in a few days.

The outcome of the condition will likely be much worse if bleeding comes back or worsens, especially within 3 to 5 days. The health care provider may recommend the following to cut down the chance that there will be more bleeding:

• Bed rest
• Eye patching
• Sedating medicines

You may need to use eye drops to decrease the inflammation or lower the pressure in your eye.

The eye doctor may need to remove the blood surgically, especially if pressure in the eye is very high or the blood is slow to absorb again. You may need to stay in a hospital.

Outlook (Prognosis)

The outcome depends upon the amount of injury to the eye. People with sickle cell disease are more likely to have eye complications and must be watched closely. People with diabetes will probably need laser treatment for the problem.

Severe vision loss can occur.

Possible Complications

Complications may include:

• Acute glaucoma
• Impaired vision
• Recurring bleeding

When to Contact a Medical Professional

Call your provider if you notice blood in the front of the eye or if you have an eye injury. You will need to be examined and treated by an eye doctor right away, especially if you have decreased vision.

Prevention

Many eye injuries can be prevented by wearing safety goggles or other protective eye wear. Always wear eye protection while playing sports, such as racquetball, or contact sports, such as basketball.

References

Lin TKY, Tingey DP, Shingleton BJ. Glaucoma associated with ocular trauma. In: Yanoff M, Duker JS, eds. Ophthalmology. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 10.16.

Olitsky SE, Marsh JD. Injuries to the eye. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 653.

Patel S, Kim SJ, Sternberg P. Surgery for ocular trauma: principles and techniques of treatment. In: Sadda SVR, Sarraf D, Freund B et al, eds. Ryan's Retina. 7th ed. Philadelphia, PA: Elsevier; 2023:chap 113.