Doctors grade hyphema based on how much blood builds up between the iris and cornea. A small amount of blood, as shown here, will have a lower grade.
A Guide to Hyphema: Pictures, Symptoms, and Causes
If you think you have hyphema, contact a doctor as it requires medical attention. If left untreated, you may sustain permanent damage to your eye, and you may experience vision loss.
This article explains what hyphema is and its causes, symptoms, diagnosis, and treatment.
Hyphema is the buildup of red blood cells in the anterior chamber of your eye. The anterior chamber of an eye is the part that includes the iris, lens, cornea, and angle.
Hyphema usually occurs after a trauma or due to certain underlying conditions, such as leukemia, sickle cell disease, or hemophilia. In people with hyphema, blood typically accumulates from the disruption of blood vessels in the iris or ciliary body.
If you have hyphema, the blood in your eye is typically easily visible during a direct inspection or when a doctor examines your eye with a slit lamp.
Doctors grade hyphema depending on the amount of blood sitting in the anterior chamber of your eye:
- Grade 0: There is no visible layering, but there are some blood cells in the anterior chamber.
- Grade 1: A layer of blood occupies less than 33% of the anterior chamber.
- Grade 2: The layer of blood fills between 33–50% of the anterior chamber.
- Grade 3: Blood fills more than 50% of the anterior chamber.
- Grade 4: Blood completely fills the anterior chamber.
Symptoms of hyphema may include:
- eye discomfort in bright light or photophobia
- presence of blood spots in the anterior chamber of the eye
- anisocoria, which is unequal pupil size in the eyes
- decreased ability to distinguish shapes and details of objects positioned at a certain distance
If you have hyphema, your symptoms may worsen when you’re lying on your back. Elevating your head may help improve your symptoms as this can help to shift the layer the blood below the visual axis.
Bhargava S, et al, CC BY-SA 4.0, via Wikimedia
In severe cases of hyphema, blood buildup may completely cover the iris.
Yoko Okunuki, Junichi Sakai, Takeshi Kezuka & Hiroshi Goto, CC BY-SA 4.0, via Wikimedia
Hyphema can cause blood to build up in at least 50% of the eye's anterior (front) chamber.
Rakesh Ahuja, MD, CC BY-SA 2.5, via Wikimedia
Most cases of hyphema occur from sports injuries. The most common cause of hyphema is blunt eye trauma. This can also cause open globe injuries and other symptoms, including continuous eye pain and vision deficit.
Other causes of hyphema include penetrating trauma and spontaneous hyphema. However, these causes are not as common as blunt trauma.
Spontaneous hyphema can occur in people with certain underlying conditions, including:
You may also experience hyphema if you’re taking anticoagulant medications.
Your doctor will typically start with a physical examination. They will also perform a slit lamp examination to assess hyphema and spot potential abrasions on the cornea. A slit lamp examination involves shining a bright light into your eye.
Once the doctor rules out any potential open globe injury, they will generally proceed with measuring the intraocular pressure. If the result of this test is greater than 21 millimeters of mercury (mm Hg), your intraocular pressure is considered high.
Your doctor may also request a blood sample for testing your blood count and the coagulation ability of your blood. If you have a family history of sickle cell disease, they may also order a test to exclude sickle cell hemoglobinopathy. However, if trauma is the known cause of hyphema, blood tests are not typically required.
Your healthcare team may perform an eye CT scan if they believe you have an open globe injury, an orbital fracture, or a foreign body in your eye. If doctors rule out an open globe injury, they may also order an ultrasound test to evaluate other potential internal eye injuries.
Treatment for hyphema depends on its causes. Depending on what your doctor discovers from the physical examination and imaging tests, they may recommend that you:
- rest (this can mean strict bedrest with only bathroom privileges)
- avoid sports activity while your eye heals
- wear a protective shield in front of your eye
- raise the head of your bed to improve blood drainage from your eye
Your doctor may prescribe eye drops to reduce swelling inside your eye. This should help improve your discomfort and pain. You may also need to regular follow-up visits to keep track of the healing process and check your eye’s internal pressure. Your doctor may recommend avoiding taking aspirin as this type of medication can cause more bleeding.
Your doctor may recommend surgery to drain the excess blood and reduce the risk of complications if there’s no noticeable improvement in your hyphema with medication alone. However, surgery is typically only performed if you have a grade IV hyphema.
Hyphema complications may include:
- acute intraocular hypertension
- corneal blood staining
Acute intraocular hypertension is generally found during hospital admission. After the initial acute phase, it’s important to regularly visit an opthalmologist to asses your intraocular pressure. They can also recommend effective treatment to manage eye pressure and prevent future complications.
Around 2.1% of people with hyphema experience corneal blood staining, according to one small case study conducted in 2001. This complication can occur in prolonged cases. Your doctor may recommend an interior chamber washout to improve symptoms.
Hyphema consists of a buildup of blood in the anterior chamber of the eye. Doctors classify the severity of hyphema depending on how much blood is filling the anterior chamber. To diagnose hyphema, they may perform an examination of your eye with a slit lamp.
The most common cause of hyphema is trauma. Your doctor may recommend rest and prescribe you eye drops and medications to help reduce swelling and discomfort. In some severe cases, they may perform surgery to drain the excess blood and reduce the intraocular pressure.
Complications of hyphema include re-bleeding and acute intraocular blood pressure. Both conditions require medical attention as they can cause vision loss and other eye problems when left untreated.
If you suspect you have hyphema, contact a doctor, such as an ophthalmologist who specializes in eye health. They will be able to assess your health and suggest the most effective treatment for your condition.