Hyphema – Blood Blade in the Eye
Hyphema occurs when blood collects near the iris and pupil. The blood pools between the cornea (the dome-shaped clear window at the front of the eye) and the lens (the eye's focusing lens). The blood may cover all or part of the iris and pupil. With hyphema, your vision may be partially or completely blurred. The condition occurs when trauma causes injury and bleeding of the iris. The eye is usually painful. This is an eye emergency requiring careful treatment and follow-up, as neglect can lead to serious long-term consequences.
What is hyphema?
Hyphema indicates bleeding from the iris into the anterior chamber of the eye.
A layer of blood, more or less high, remains trapped between the iris and the cornea.
It is most often secondary to trauma.
Symptoms
The symptoms of hyphema are:
Bleeding in the front of the eye – A red line is visible in front of the pupil, it may cover it in whole or in part.
Photophobia – Sensitivity to light.
The pain in the eye.
Blurred, cloudy or absent vision (total hyphema).
Causes
Hyphema is usually caused by an eye injury during an accident. It can be caused by other, less common factors, such as:
Blood clotting problems.
Lesions caused by the cataract implant (UGH syndrome).
Iris bleeding during laser treatment: peripheral iridotomy.
Abnormal blood vessels on the surface of the iris.
Eye infections caused by a herpes virus.
In exceptional cases, eye cancers.
A closer look at UGH syndrome – When the cataract implant causes the iris to bleed.
There is a rare but underdiagnosed complication of cataracts, UGH syndrome, for Uveitis, Glaucoma and Hypertonia.
The vision-correcting implant rubs against the back of the iris and causes it to bleed repeatedly.
The diagnosis is confirmed by UBM ultrasound .
The implant must then be repositioned or changed before the eye is too damaged by the spikes in ocular pressure.
Risk factors
Since most hyphemas occur as a result of sports injuries , it is important to wear protective eyewear. Sports injuries, especially those involving small balls (like tennis balls), can cause serious eye problems.
Besides hyphema, these injuries can cause cataracts, retinal detachment, and glaucoma, and lead to blindness. An article on eye trauma is available via the link.
If you injure your eye, consult an ophthalmologist immediately.
Diagnosis
The ophthalmologist will thoroughly examine your eye to diagnose hyphema. They will check:
Your visual acuity – Ability to see
Intraocular pressure – Hyphema is often associated with hypertension (increased pressure in the eye)
The fundus – Sometimes difficult to observe due to blood present in the anterior part of the eye. The presence of blood in the vitreous humor is sought.
In some cases, the ophthalmologist may request a conventional (B-scan) and high-resolution (UBM) ultrasound of the eye. These examinations allow for the evaluation of the iris and the eyeball through the blood.
Treatment
Treatment for hyphema helps to reduce the blood while limiting ocular complications. The following treatments may be undertaken:
Rest & cessation of physical activity.
Stopping blood-thinning medications: anticoagulants and antiplatelet agents (only on the advice of the prescribing colleague).
Anti-inflammatory and mydriatic eye drops to limit adhesions of the pupil to the lens.
Hypotensive eye drops and tablets – To lower intraocular pressure.
Surgical lavage may be undertaken in cases of refractory ocular hypertension or hyphema that does not clear up after several days in order to limit potential complications.
Complications
Hyphema is fundamentally a serious eye condition. Its two main complications are:
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Refractory ocular hypertension – Leading to glaucoma and serious optic nerve damage.
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Corneal hematocytosis – Blood invades the eye's first transparent lens: the cornea. The damage is then irreversible, and only a corneal transplant can restore vision.