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(Anterior Chamber Hemorrhage)

By Kathryn Colby, MD, PhD, Louis Block Professor and Chair, Department of Ophthalmology & Visual Science, University of Chicago School of Medicine

A hyphema is bleeding into the front chamber (the fluid-filled space between the clear cornea and the colored iris—see Figure: An Inside Look at the Eye) of the eye. Additional bleeding may occur up to several days after the injury. A hyphema may result in permanent, partial, or complete loss of vision. Vision loss may be caused by increased pressure within the eye (glaucoma), by blood staining the cornea, or both.

People with hyphema often have blurred vision and pain when exposed to bright light. If the hyphema is large enough, a layer of blood is visible behind the lower part of the cornea when the person is upright. However, the layer may be so small that it can be seen only with magnification.

Treatment of Hyphema

  • Bed rest with the head of the bed elevated

  • A protective shield over the eye

  • Eye drops

A person with a hyphema should be examined by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment—surgical and nonsurgical—of eye disorders) as soon as possible. Some people with severe bleeding or bleeding disorders (which make bleeding more likely) or who take anticoagulant drugs may need to be treated in the hospital.

Treatment usually involves bed rest with the head of the bed elevated to encourage the blood to settle. Eye drops are often given to dilate the pupil (such as atropine) and to reduce inflammation within the eye (usually corticosteroids). A protective shield is taped over the eye to prevent further injury.

Pressure within the eye is measured at least once daily for the first few days. If the pressure is elevated, people may have nausea, eye ache, and decreased vision. The ophthalmologist may give eye drops such as those used to treat glaucoma to decrease the pressure. Aspirin and other nonsteroidal anti-inflammatory drugs, which can predispose to bleeding, should be avoided for several weeks. Because a hyphema increases the life-long risk of developing glaucoma, people who have had a hyphema should have their eyes examined every year.

If bleeding recurs, an ophthalmologist may give aminocaproic acid, a drug that hastens blood clotting. Rarely if recurrent bleeding causes increased pressure in the eye, the blood may need to be drained surgically.

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