Hyphema (Blood in the Eye): Causes, Symptoms & Treatment

Usually caused by trauma from playing contact sports or other physical activities, bleeding can occur inside of the eye. These hyphemas will typically go away on their own and rarely require more than basic treatments. 

Hyphema can be prevented by wearing eye protection when playing sports or participating in other physical activities that put the eyes at risk.

What Is Hyphema? 

Hyphema is the term used when there is bleeding inside of a person’s eye. This is most commonly caused by physical trauma. Red blood cells accumulate in the anterior chamber of the eye, which is behind the cornea and the iris. 

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Hyphema Grading Levels

There are five different levels, or numerical grades, when determining the severity of hyphemas that are based on the amount of blood present.

Grade 0 (Microhyphema)

Red blood cells can be detected by a microscopic examination, but there is no visual layered clot noticeable to the naked eye. 

Grade I

Less than 33 percent of the anterior chamber is occupied by blood. 

Grade II

About 33 to 50 percent of the anterior chamber is occupied by blood.

Grade III

Approximately 50 to 99 percent of the anterior chamber is occupied by blood.

Grade IV

Blood completely fills the entire volume of the anterior chamber. This grade of hyphema is sometimes referred to as total hyphema or 8-ball fracture.

What Causes Hyphema?

Hyphemas are most commonly caused by blunt trauma to the eye. Children are most susceptible to traumatic hyphemas since they can get them while playing contact sports or from falling down. Eye surgeries can also cause traumatic hyphemas. 

In other cases, a hyphema can be spontaneously developed in connection to other medical conditions. Spontaneous hyphemas are usually caused by the following:

• Growth of new blood vessels (ocular neovascularization)
• Tumors and melanoma in the eye
• Eye infections
• Inflammation of the eye (uveitis)
• Diseases such as sickle cell anemia, thalassemia, and leukemia

Symptoms of Hyphema

In addition to blood filling up the anterior chamber of the eye, there are other coinciding symptoms of hyphema. These include the following: 

• Being overly sensitive to light 
• Pain or discomfort in the affected region
• Cloudy or blurry vision

In extreme cases, vision can also be temporarily blocked by the clotted blood. Symptoms of hyphema can vary depending on the severity and grade of each case.

Diagnosing Hyphema

Though both conditions involve blood vessels in the eye, hyphemas should not be confused with subconjunctival hemorrhages. The latter is much more common. It occurs when blood vessels break on the surface of the eye and are not confined to the eye’s anterior chamber. 

Hyphemas occur when there is bleeding inside of the eye and can be properly diagnosed by an ocular examination. A regular penlight examination can detect larger, higher graded hyphemas. Slit lamp examinations of the anterior chamber can detect smaller, lower graded hyphemas.  

How Is Hyphema Treated?

Most hyphemas will go away on their own, and no treatment is required. However, it is still important to meet with a doctor to ensure that the hyphema is not a more serious condition. 

In other cases, an ophthalmologist may have recommendations to ensure that the affected area heals properly and does not cause any further complications. These remedies include the following:

• Wear an eyepatch or a specially made shield over the eye.
• Don’t participate in any physical activity that may further damage the area.
• Keep your head elevated when sleeping to help drain the eye.
• Use prescription eye drops that help to ease swelling in certain cases of higher graded hyphemas.

Although it is very rare, a small amount of higher graded hyphemas can increase eye pressure so much that it can cause damage to the cornea or lead to glaucoma. Surgery may be required in these rare instances. 

Complications: Are There Any Long-Term Effects From Hyphema?

During the first week of developing hyphema, a person is at a higher risk of additional ocular damage and internal bleeding. Although rare, this can potentially lead to partial vision loss or complete blindness in the eye that has a hyphema.

There can also be certain long-term effects from hyphema. The initial trauma to the eye can sometimes permanently damage the eye’s drainage canal. In this scenario, intraocular pressure is increased. This elevated pressure can lead to a lifelong risk of both developing glaucoma and permanent optic nerve damage. 

How Do I Prevent Hyphema?

The best way to prevent hyphema from occurring is to wear appropriate eye protection in situations where the eyes are at risk of physical trauma. Safety goggles or similar protective eyewear should be used in the following situations:

• Playing contact sports where a ball or other projectile could potentially strike the eye
• Working with heavy machinery that can cause flying projectiles
• Using power tools, such as saws or drills, that usually result in an abundance of debris

Hyphema can be easily avoided in most cases. If an individual does develop the condition, it typically goes away without major medical intervention. However, it is important to always consult with an eye care specialist to ensure that blood in the eye is not a more serious condition.

References

1. Cornea and Anterior Eye Assessment With Slit Lamp Biomicroscopy, Specular Microscopy, Confocal Microscopy, and Ultrasound Biomicroscopy. (February 2018). Indian Journal of Ophthalmology.

2. Hyphema. (September 2022). StatPearls.

3. Medical Interventions for Traumatic Hyphema. (January 2019). Cochrane Library of Systematic Reviews.

4. Mental Status Changes and Bradycardia: Don’t Forget the Eye! Traumatic Hyphema Can Mimic Increased Intracranial Pressure. (September 2008). Clinical Pediatrics.

5. Ocular Neovascularization. (January 2018). Journal of Molecular Medicine.

6. Poor Final Visual Outcome After Traumatic Hyphema: A Retrospective Study of Associated Factors. (2012). Journal of Emergency Medicine Trauma & Acute Care.

7. Thalassemia. (August 2022). StatPearls.

8. Traumatic Hyphema: A Teaching Case Report. (2014). Optometric Education.

9. What Is Hyphema? (May 2022). American Academy of Ophthalmology.