The anterior chamber of the eye is characterized by hyphema, a condition resulting from ruptured blood vessels in the iris or the ciliary body that leak into the cornea. In addition to blurred vision, pain, sensitivity to light, and increased eye pressure, this can cause a variety of problems.
Hyphema can be caused by several factors, such as:
The most common cause of hyphema is trauma, such as a blunt or penetrating injury to the eye, which can damage the blood vessels or the structures of the eye and cause bleeding.
A medical condition, such as diabetes, sickle cell disease, leukemia, or hemophilia, can affect the blood vessels or blood clotting, increasing the risk of bleeding.
Medications such as aspirin, warfarin, or ibuprofen, which can thin the blood or interfere with blood clotting, and increase bleeding risk. In people with eye problems or who are prone to hyphema, medications should be taken with caution and under the doctor's supervision.
Surgery can cause hyphema as a side effect or complication, such as cataract surgery, glaucoma surgery, or corneal transplant surgery, which can involve manipulation of the eye structures or the use of instruments.
Hyphema can affect anyone, regardless of age, gender, or ethnicity, but it is more common in people who have eye problems, blood disorders, or a history of eye trauma or surgery.
The symptoms of hyphema depend on the severity and the duration of the condition, and the amount of blood in the anterior chamber. Some common symptoms include:
Blurred vision, or the loss of vision, due to the blood blocking the light from entering the eye or reaching the retina.
Pain, or the feeling of pressure or discomfort in the eye, due to the blood irritating the cornea or the iris, or the increased eye pressure.
Photophobia, or the sensitivity to light, due to the blood reflecting the light or the pupil being unable to adjust to the light.
Redness, or the appearance of a red or a dark spot in the lower part of the eye, due to the blood being visible through the cornea.
Hyphema can affect the quality of life, the vision, and the eye health of the person. It can also increase the risk of other complications, such as glaucoma, corneal scarring, or vision loss.
Hyphema can be diagnosed by an eye doctor, who will perform a physical exam and ask the person about their medical history, their family history, and their symptoms. The eye doctor will also order some tests and procedures, such as:
A slit-lamp exam, which uses a microscope and a bright light to examine the structures of the eye, such as the cornea, the iris, and the anterior chamber, and to detect the presence, the size, and the location of the blood.
A tonometry test, which measures the pressure inside the eye using a device called a tonometer, and to detect the signs of glaucoma, such as high eye pressure or optic nerve damage.
A gonioscopy test, which uses a special lens and a slit-lamp to examine the angle between the cornea and the iris, and to detect the signs of angle-closure glaucoma, such as a narrow or a closed angle.
A blood test, which measures the levels of blood cells, clotting factors, and glucose in the blood, and to detect the signs of blood disorders, such as anemia, sickle cell disease, or diabetes.
An ultrasound, which uses sound waves to create images of the eye, and to detect the signs of eye injury, such as a foreign body, a tear, or a detachment of the iris or the retina.
The eye doctor will use the results of the tests and the history to determine the diagnosis and the prognosis of hyphema, and to prescribe the appropriate treatment.
The treatment of hyphema aims to stop the bleeding, clear the blood, relieve the symptoms, and prevent the complications of the condition. The most common treatments are:
Medications, which are used to control the bleeding, the inflammation, and the eye pressure, and to reduce the pain and the sensitivity to light. They include:
Cycloplegics, which dilate the pupil and relax the eye muscles, and prevent the iris from moving and rubbing against the blood or the lens.
Steroids, which reduce the swelling and the inflammation in the eye, and prevent the formation of scar tissue or adhesions.
Antiglaucoma agents, which lower the eye pressure and improve the drainage of the fluid in the eye, and prevent the damage to the optic nerve or the vision.
Analgesics, which relieve the pain or the discomfort in the eye, and improve the comfort and the quality of life of the person.
In severe cases of bleeding, high eye pressure, or vision loss, surgery is a more invasive and definitive way to treat hyphema, especially when medications are not effective or are not tolerated. Viralectomy involves removing the vitreous gel from the back of the eye and replacing it with a clear fluid or gas, or using a needle, syringe, or suction device to remove the blood from the anterior chamber. A thorough evaluation is required before the surgery, and the person must follow the postoperative instructions carefully. The surgery is performed under local or general anesthesia, and has a high success rate. A variety of risks and complications may result from the surgery, including infection, inflammation, bleeding, and cataracts.
Lifestyle changes, which are important to support the treatment and to prevent the recurrence of hyphema. They include:
Resting the eye, by keeping the head elevated, avoiding any eye movements or rubbing, and wearing an eye patch or a shield, to prevent the blood from moving or clotting in the eye, and to promote the healing and the reabsorption of the blood.
Avoiding any activities, such as sports, exercise, or driving, that may increase the blood pressure or the eye pressure, or cause further trauma or injury to the eye, and worsen the condition of hyphema.
Protecting the eye, by wearing sunglasses, hat, or visor, to shield the eye from the light or the dust, and prevent the irritation or the infection of the eye.
Taking the prescribed medications, and adjusting them as needed, under the eye doctor’s supervision.
Individuals' treatment choices are influenced by their age, hyphema cause and severity, the presence of symptoms or complications, their overall health, and their personal preferences. To help the person make the best decision, the eye doctor will discuss the pros and cons of each option.
The majority of hyphema cases are caused by genetic and environmental factors that affect blood vessels or eye structures, so it cannot be prevented. In order to protect their eye health and prevent episodes or complications of hyphema, the person can:
Having regular eye exams, at least once a year, or more often if recommended by the eye doctor.
Taking the prescribed medications, and adjusting them as needed, under the eye doctor’s supervision.
Following the proper hygiene and care instructions for the eye devices, if applicable, and reporting any signs of malfunction or infection.
Seeking medical attention, if they notice any symptoms of hyphema, such as blurred vision, pain, or redness.
Educating themselves and their family members about hyphema, its causes, its symptoms, its diagnosis, its treatment, and its prevention.
When a person understands the causes, symptoms, diagnosis, treatment, and prevention of hyphema, they can take control of their eye health and enjoy a better quality of life.
