(See also Overview of Eye Injuries.)
A hyphema will usually resolve with medical treatment, but requires monitoring as it can 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.
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 and rebleeding 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 and minimize scarring within the eye (usually corticosteroids). A protective shield is taped over the eye to prevent further injury.
Doctors measure pressure in the eye at least once daily for the first few days. This measurement is taken painlessly with an instrument called a tonometer. 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 if possible. 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 is severe or recurs, an ophthalmologist may give aminocaproic acid or tranexamic acid, which are drugs that hasten blood clotting. Rarely if recurrent bleeding causes increased pressure in the eye, the blood may need to be drained surgically.
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