What is hyphema?
Hyphema is the medical term for bleeding inside your eye. Specifically, hyphema causes blood to pool behind your cornea (the outermost layer of your eye) and your iris (the colored part of your eye). It’s usually caused by something hitting your eye. Sports injuries are the most common cause of hyphema.
Most people recover from a hyphema with only at-home treatment in a few days. It’s rare to need surgery. However, severe hyphema can cause blindness in the affected eye.
It’s important to get your eye examined by your healthcare provider or in the emergency room as soon as you notice bleeding in your eye.
Hyphema vs. subconjunctival hemorrhage
Hyphema is bleeding inside your eye that causes blood to pool between the layers within your eye. A subconjunctival hemorrhage is a term for a broken blood vessel on the surface of the eye. It will look like a small red spot on your eye. Subconjunctival hemorrhages are more common and less serious than hyphema.
Talk to your provider if you notice blood in your eye, especially if it’s after an injury or trauma.
Who does hyphema affect?
Hyphema can affect anyone, but it’s very rare. It usually affects kids injured during sports. In fact, more than 70% of hyphema cases involve children.
How does hyphema affect my body?
The most obvious way hyphema affects your body is the bleeding in your eye. The blood building up inside your eye might affect your vision.
Symptoms and Causes
What are the symptoms of hyphema?
Symptoms of hyphema include:
- Blood inside your eye.
- Eye pain.
- Blurry or distorted vision.
- Light sensitivity.
What causes hyphema?
Anything that hits your eye can cause hyphema. Trauma to your eye — usually a sports injury — is the most common cause. Sports that cause hyphema include:
Airbags going off during a car accident cause hyphema too.
Hyphema caused by medical conditions
Hyphema can also be caused by medical conditions that affect your blood, including:
Medicines you take that thin your blood (anticoagulants) can also lead to hyphema.
Hyphema caused by eye surgery
It’s rare, but you can develop hyphema after having eye surgery. If you need surgery for glaucoma or to insert an artificial lens in your eye, you might experience hyphema after the operation.
Sometimes, your eyes are irritated after surgery and they develop uveitis and hyphema. Talk to your provider or surgeon if you have pain, bleeding or other symptoms after eye surgery.
Diagnosis and Tests
How is hyphema diagnosed?
Your healthcare provider will diagnose hyphema by looking at your eyes and performing a physical exam to check for other symptoms. You might need some tests, including:
Your provider will grade the hyphema, depending on how much blood is collecting in your eye. The grades range from 0 (no visible blood inside your eye) to 4 (your eye’s anterior chamber is completely filled with blood). Grade 4 hyphema is sometimes called an “eight ball” or “blackball” hyphema.
See your provider as soon as possible after you notice any blood inside your eye.
Management and Treatment
How is hyphema treated?
If the hyphema is a lower grade and isn’t causing other symptoms or issues, you’ll only need at-home treatment. Conservative treatments usually include:
- Rest: Avoid intense activity that might raise the pressure inside your eye while it recovers.
- Wearing an eye patch: A patch will protect your eye from additional irritation and will help it relax while it heals.
- Elevating your head: Keeping your head raised above your heart will help the built-up blood drain away from your eye back into your body.
Only around 5% of people with hyphema need surgery to repair it. If you have severe bleeding and pressure inside your eye that doesn’t start to improve within 24 hours — or if your symptoms are severe enough to permanently damage your eye — you might need surgery.
Your surgeon will drain the blood from inside your eye to remove the pressure.
How to take care of myself?
Follow any directions from your provider or surgeon while you’re recovering from hyphema. If you have a patch to wear, make sure you wear it for as long and as often as you should. Hyphema usually resolves on its own in a few days.
Even if you only need conservative treatment, the first five days after you develop hyphema are the most important. You’ll be at a higher risk of re-aggravating your eye, which can cause the bleeding to start again. This can lead to serious complications, including permanent vision loss.
How can I reduce my risk?
Make sure you’re wearing the correct eye protection when you’re playing sports or doing any activity that could cause something to be thrown at or into your eye. Always wear safety glasses or goggles when working with tools.
Outlook / Prognosis
What can I expect if I have this condition?
For most people, hyphema is a temporary result of an injury that will get better in a few days. The bleeding will stop, the blood will drain back into your body and your eye will return to its usual appearance and function.
Even if they’re rare, injuries that cause hyphema can cause permanent damage to your eye and vision.
When should I see my healthcare provider?
Visit your healthcare provider or go to the emergency room right away if you notice any changes in your eyes or vision, especially if you notice blood inside your eye.
Go to the emergency room right away if you’ve experienced a trauma or something hits your eye hard enough to make it bleed.
What questions should I ask my doctor?
- What’s causing the hyphema?
- Will I need any tests?
- What treatment will I need?
- How long will recovery take?
A note from Cleveland Clinic
Hyphema is a scary-looking result of an injury to your eye. Even if it’s usually a temporary issue, you should visit your provider or the emergency room as soon as you notice blood in your eye — especially if you were hit directly in the eye. Always take any changes in your eyes seriously and have them checked out by a provider right away.
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