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Hyphema

Fig. 1 A hyphemia is an accumulation of blood in the space between the cornea and the iris.

What is a hyphema?

A hyphema is an accumulation of blood in the space between the cornea and the iris

What causes a hyphema?

A hyphema is most often caused by blunt trauma to the eye. It can also occur as a result of surgery inside the eye. Rarely hyphema occurs as a consequence of medical problems that affect the eye (juvenile xanthogranuloma, leukemia, retinoblastoma).

What are the symptoms associated with a hyphema?

Typical symptoms include eye pain, sudden blurring or loss of vision, and light sensitivity.

How does a hyphema cause eye pressure elevation?

The blood in the anterior part of the eye can clog the drainage canal resulting in elevated eye pressure. Sometimes the trauma actually damages the drainage system of the eye and causes elevated eye pressure.

What considerations are there for persons with sickle cell anemia and hyphema?

The sickle red blood cells can severely clog the drainage mechanism of the eye resulting in significant pressure elevation. Drugs containing carbonic anhydrase inhibitors are avoided as they can exacerbate the problem.

How is a hyphema treated?

Treatment of a hyphema involves encouraging the blood to clear, treating any associated eye pressure elevation and trying to prevent re-bleeding.

A period of limited activity or bed rest is recommended. The head is kept in an elevated position and the eye protected with a shield. Steroid drops are often prescribed to limit inflammation and the pupil dilated to alleviate pain. Medicines containing aspirin or ibuprofen should be avoided

When is surgery recommended?

Surgery is performed when a large hyphema or clot does not clear with conservative treatment, when the cornea stains with blood and/or eye pressure elevation cannot be controlled medically.

What other eye injuries might be associated with a traumatic hyphema?

The lens of the eye may be displaced, ruptured or may develop a cataract. The eye drainage canal may be damaged resulting in glaucoma. There may be blood in the vitreous cavity and the retina may be damaged. The extent of damage depends on the force of the blunt trauma and the Eye MD thoroughly evaluates for problems that occur concurrently with hyphema.