A hyphema occurs when there is bleeding in the front of the eye between the cornea and lens. This may result from blunt trauma to the eye. Hyphemas may cause a great deal of pain or eye pressure. Blood may be seen filling the anterior chamber between the cornea and the colored iris. A hyphema usually initially diminishes vision. In addition to being caused by blunt trauma to the eye, hyphemas can also occur following eye surgery and in association with severe diabetic eye disease.
Vision may blur with a hyphema; a patient may be sensitive to light. Patients may experience varying levels of pain, usually caused by elevated eye pressure. There may be visible blood in the eye or blood cells may be only visable with a special microscope called a slit lamp.
Many hyphemas are mild or small, and heal in 5-6 days. Rarely hyphemas result in rebleeding, staining of the cornea, severe glaucoma and permanent loss of vision. Treatment includes the use of dilating drops, cornticosteroid eye drops, and medications to lower eye pressure. Sometimes oral medications to prevent rebleeding or to lower eye pressure are necessary. Patients should stay at bed rest and avoid reading for the first 5 days after a bleed in the eye. An eye shield may be used to protect against eye rubbing or pressure on the eye during sleep, which could result in rebleeding. Aspirin, ibuprofen and anything else that “thins” blood should be avoided to lower the risk of causing the eye to bleed again. The head should be elevated” while sleeping to prevent the blood from covering the pupil.
In rare cases, hyphemas do not respond to medical treatment and require surgery to clean the anterior chamber of blood and thus prevent blood staining the cornea that can occur with elevated eye pressure. Increased eye pressure from the blood of the hyphema can also damage the optic nerve which brings vision from the retina to the brain. This glaucoma may be resistant to medical treatment and require surgery to prevent permanent loss of vision.