Hyphema (Bleeding in the Anterior Chamber)

A hyphema is a collection of blood in the anterior chamber of the eye – the space between the cornea and the iris. It is a serious eye injury that must be treated by an ophthalmologist immediately to prevent lasting damage.

Causes

The most common cause is a blunt injury to the eye – for example from a ball, an elbow, or a fall. Other possible causes are:

Eye injuries during sports: especially ball sports without protective glasses
Following eye surgery: as a complication after intraocular procedures
Abnormal blood vessels: in certain eye diseases (e.g. neovascularization in diabetes or after vascular occlusions)
Blood clotting disorders: congenital or medication-related clotting disorders increase the risk
Sickle cell anemia: patients with sickle cell disease have an increased risk of serious complications from a hyphema

Symptoms

Visible collection of blood in the eye (a reddish layer in front of the iris, especially when sitting upright)
Blurred vision or deterioration of vision
Eye pain
Light sensitivity
In severe hyphema: the entire eye appears dark red

Grades of severity

Grade I: blood fills less than one third of the anterior chamber
Grade II: one third to half of the anterior chamber is filled
Grade III: more than half of the anterior chamber is filled with blood
Grade IV (total hyphema / "eight-ball"): the entire anterior chamber is filled with blood and appears black

Treatment

The treatment aims to prevent further bleeding and to control the intraocular pressure:

Rest with the upper body elevated: the head is raised (30–45 degrees) so that the blood settles at the bottom of the anterior chamber and impairs vision less.
Eye protection: a shield (not an eye patch) protects the eye from further blows.
Cortisone eye drops: to reduce inflammation.
Pupil-dilating drops (mydriatics): keep the iris still and relieve pain.
Avoiding aspirin and ibuprofen: these medications inhibit blood clotting and increase the risk of rebleeding. If pain medication is needed, paracetamol (acetaminophen) is the safer choice.
Pressure-lowering eye drops: if the intraocular pressure is raised.
Surgery: in severe cases – such as blood that does not clear, very high intraocular pressure, or impending corneal damage – the blood can be removed surgically.

Rebleeding

In the first 3–5 days after the initial injury, there is a risk of renewed bleeding (rebleeding), which is often heavier than the first. For this reason, physical rest and regular check-ups are particularly important during this phase.

Possible complications

Raised intraocular pressure: the blood can block the outflow of aqueous humor and cause secondary glaucoma.
Corneal blood staining: prolonged contact with blood can discolor the cornea.
Long-term glaucoma risk: even after healing, the intraocular pressure should be checked regularly in the following years.

Prevention

Many hyphema cases in children and adolescents can be avoided by wearing sports protective glasses with polycarbonate lenses – especially during ball sports and other high-risk activities.