Hyphema

  • Hemorrhage layered in anterior chamber of eye
  • Usually caused by blow to eye that tears blood vessels at iris root
  • Other signs of ocular or orbital contusion often come with it: vision loss, diplopia, lid swelling or laceration, ptosis, orbital fractures, rupture of eye, cataract, vitreous hemorrhage, or damage to cornea, retina, optic nerve
  • Hyphema by itself is a concern because of elevated intraocular pressure and corneal blood-staining
  • Pain and blurred vision
  • Crescent-shaped layer of blood at bottom of anterior chamber
  • Iris and pupil may be obscured by blood in anterior chamber
  • Cornea may appear turbid because of contusion or high intraocular pressure
  • Conjunctival vessels usually appear engorged
  • Nothing—challenge is to recognize layered blood
  • Shield eye and refer emergently to ophthalmologist
  • Medications to lower intraocular pressure may be necessary
  • Rebleeding is a concern within next 48 hours
  • Topical cycloplegics and corticosteroids may reduce chance of rebleeding
  • If hyphema is mild, often clears spontaneously, but...
  • Surgical evacuation may be necessary if intraocular pressure cannot be controlled
  • If intraocular pressure remains high, may lead to blood-stained cornea as blood seeps into cornea