hyphemas

Hyphema refers to blood within the anterior chamber of the eye, the space between the cornea and the iris. When multiple blood accumulations occur or are described across different times, the term hyphemas may be used. Hyphemas are most often caused by trauma but can also follow intraocular surgery, laser procedures, or result from vascular abnormalities or systemic disorders that affect coagulation.

Common causes and risk factors include blunt or penetrating eye injuries, postoperative bleeding after cataract or glaucoma surgery, and ocular conditions with abnormal neovascularization. Systemic coagulopathies, anticoagulant or antiplatelet therapy, and diseases such as diabetes or sickle cell disease can increase the risk or severity. The degree of bleeding is typically graded by the amount of the anterior chamber occupied by blood.

Clinical features include sudden vision disturbance and eye redness, pain, and photophobia after injury. A slit-lamp examination confirms blood in the anterior chamber and allows assessment of the grade, pupil size, corneal clarity, and intraocular pressure. An evaluation may include gonioscopy to assess angle involvement and ocular ultrasonography if the view is blocked or retinal detachment is suspected. Elevated intraocular pressure can accompany hyphema and requires separate management.

Treatment focuses on protecting the eye and preventing rebleeding and complications. Immediate steps include eye shielding, upright head position, and avoidance of activities that raise venous pressure. Medical management may involve topical corticosteroids to reduce inflammation, cycloplegics to relieve pain and prevent synechiae, and intraocular pressure–lowering medications as needed. Anticoagulants or antiplatelet therapy may be adjusted in consultation with the patient’s physician. In some cases, persistent or high-grade hyphema, elevated intraocular pressure, or poor clearing may require surgical intervention such as anterior chamber washout.

Prognosis is generally favorable for simple, nontraumatic cases, with most hyphemas resolving within days to a week. However, rebleeding, sustained elevated intraocular pressure, corneal blood staining, or secondary glaucoma can occur, potentially affecting vision if not promptly managed.