hyphema

Hyphema is the accumulation of blood in the anterior chamber of the eye, the space between the cornea and the iris. It is usually the result of trauma and is graded by the amount of blood present, from small (less than one third of the chamber) to total (blood fills most or all of the chamber).

Traumatic blunt injury is the most common cause, but hyphema can also follow penetrating injuries, intraocular surgery, or occur spontaneously in people with bleeding disorders, anticoagulant use, sickle cell disease, or iris neovascularization. Less common causes include intraocular tumors and ocular inflammation.

Patients typically present with decreased vision, light sensitivity, and sometimes eye pain. Slit-lamp examination confirms blood in the anterior chamber and allows grading. Intraocular pressure should be measured, and gonioscopy or imaging may be needed if the view is obscured. Evaluation for additional ocular injuries and systemic factors is important.

Management is usually conservative. Protect the eye with a shield, keep the head elevated, and restrict strenuous activity. Avoid NSAIDs and aspirin. An urgent ophthalmology consultation is essential. Treatments may include topical corticosteroids and cycloplegics; intraocular pressure-lowering medications may be used if pressure is elevated. Large or persistent hyphemas, persistent high intraocular pressure, or signs of corneal blood staining may require surgical intervention.

Most hyphemas resolve within a few days, but there is a risk of rebleeding, particularly within the first week. Complications can include secondary glaucoma, corneal blood staining, synechiae, cataract, and, rarely, vision loss.