Hyphema is a condition where blood fills the anterior chamber of the eye, often caused by traumatic injury or medical conditions. Treatment involves rest, an eye patch, and medication, with recovery usually within a week.
Hyphema is a condition in which the anterior chamber of the eye fills with blood. The anterior chamber is located between the iris and the cornea and is filled with a fluid called aqueous humor. When hyphema occurs and the chamber contains blood, the effect is often to partially or completely darken the pupil of the eye, making this condition relatively easy to notice and diagnose.
While hyphema itself is easily apparent, what isn’t always apparent is the means by which the condition arose. The most common cause is a traumatic injury to the eye, but some medical conditions can also lead to blood in the anterior chamber. Conditions such as diabetes, tumors such as retinoblastoma, and structural vascular abnormalities in or near the eye can all contribute to the development of spontaneous hyphema. Blood can also fill the anterior chamber of the eye during or after eye surgery.
Regardless of the event that triggers the injury, the underlying cause of most hyphemas is the same type of event. In most cases, the tissue in the back region of the eye is displaced as a result of an impact injury and this causes a sudden shift that displaces and can tear both the iris and the lens of the eye. If a tear occurs, the anterior chamber can start to accumulate blood.
Hyphemas are usually classified based on the amount of blood filling the anterior chamber and the condition of the blood. Grade 1 injuries are those in which blood fills less than a third of the chamber. In grade 2 injuries, the chamber is one-third to one-half filled with blood. A grade 3 lesion means the anterior chamber is at least half filled and may be completely filled with blood. In a grade 4 injury the blood in the anterior chamber has clotted.
Most of these lesions are grade 1, with nearly 60% involving an anterior chamber no more than one-third full. In about 15% of cases, the chamber is between half and completely full. Although only grade 4 refers specifically to clotted blood, it should be noted that overall, about 40% of hyphemas involve at least one small clot.
Treatment of hyphema typically consists of bed rest, an eye patch, and medications to prevent further bleeding, limit inflammation, and promote healing. When hyphemas occur without complications, they usually resolve within a week and result in the recovery of at least 20/40 vision in the injured eye. In some cases, however, particularly when large clots form, the injury can lead to more serious vision loss.
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