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Hyphema (hemorrhage in the anterior chamber of the eye).
Last reviewed: 07.07.2025
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Hyphema (bleeding into the anterior chamber of the eye) is an eye injury that requires immediate attention from an ophthalmologist. Potential sequelae include recurrent bleeding, glaucoma, and blood staining of the cornea, all of which can lead to permanent vision loss.
[ Symptoms of hyphema
Symptoms are related to the associated lesions unless the hyphema is large enough to obscure vision. Direct examination usually reveals layering of blood, blood clots, or both in the anterior chamber. Layering of blood appears as a meniscus-like level of blood in the lower anterior chamber. Microhemorrhage is a less severe form and may appear as a darkening of the anterior chamber on direct examination or as a suspension of red blood cells on slit-lamp examination.
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Treatment of hyphema
The patient is prescribed bed rest with the head elevated by 30", with a plate protecting the eye from additional trauma. Patients with a high risk of rebleeding (e.g. with a large hemorrhage in the anterior chamber, hemorrhagic diathesis, receiving anticoagulants, suffering from sickle cell anemia), with difficult to control elevated intraocular pressure (IOP), even without complaints, can be hospitalized. NSAIDs for local and enteral use are contraindicated, as they can contribute to rebleeding. Intraocular pressure can increase both acutely (within an hour, usually in patients with sickle cell anemia), and after months and years. In this regard, intraocular pressure is monitored daily for several days, then regularly in the following weeks and months, and when symptoms appear (e.g. eye pain, decreased visual acuity, nausea - as in acute angle-closure glaucoma). If the pressure increases, 0.5% timolol solution twice daily, 0.2% or 0.15% brimonidine solution twice daily, separately or simultaneously. The result is assessed by the pressure level, which is monitored every hour or two until the indicators are normalized or an acceptable rate of decrease is achieved; then it is usually measured 1-2 times a day. Also prescribed are pupil constrictor drops (eg, 1% atropine solution 3 times a day for 5 days) and topical glucocorticoids (eg, 1% prednisolone solution 4-8 times a day for 2-3 weeks). Intravenous infusion of aminocaproic acid at a dose of 50-100 mg / kg (but not more than 30 g per day) every 4 hours can reduce the likelihood of rebleeding. A physician without experience in ophthalmology should not use dilating and constricting drops in these cases. Rarely, with rebleeding with secondary Glaucoma may require surgical evacuation of the hematoma.