Hyphema

The front chamber of the eye, called the anterior chamber, is normally filled with a clear fluid called aqueous humor. A hyphema occurs when blood leaks into this space.

The amount of blood can vary widely:

Some patients have only microscopic blood cells visible during an examination.
Others have a visible layer of blood settling at the bottom of the eye.
In severe cases, the entire anterior chamber can fill with blood, sometimes referred to as an “eight-ball hyphema.”

The amount of blood does not always predict the final visual outcome, but larger hyphemas generally carry a higher risk of complications.

What Causes a Hyphema?

Eye Trauma

Blunt trauma is the most common cause of hyphema.

Examples include injuries from:

Sports-related accidents
Balls or projectiles
Fists
Falls
Airbag deployment
Workplace injuries

Eye Surgery

A hyphema can occasionally occur following eye surgery or other procedures.

Abnormal Blood Vessel Growth

Conditions that promote new blood vessel formation can lead to spontaneous bleeding, including:

Diabetic retinopathy
Retinal vein occlusion
Ocular ischemic syndrome

Blood Disorders

Certain medical conditions increase the risk of bleeding, such as:

Sickle cell disease
Sickle cell trait
Bleeding disorders
Use of blood-thinning medications

Tumors and Inflammation

Rarely, eye tumors or inflammatory conditions may contribute to spontaneous hyphema.

What Are the Symptoms?

Symptoms vary depending on the amount of bleeding.

Common symptoms include:

Visible blood in the front of the eye
Blurred or decreased vision
Eye pain
Sensitivity to light (photophobia)
Headache
A sensation of pressure in the eye

Some patients notice a reddish tint or a fluid level inside the eye.

How Is Hyphema Diagnosed?

Prompt evaluation by an ophthalmologist is important.

Comprehensive Eye Examination

Your doctor will assess:

The amount of blood present
Visual acuity
Eye pressure
Pupil function
Associated injuries

Slit-Lamp Examination

A slit lamp allows detailed examination of:

The cornea
Anterior chamber
Iris
Lens

Measurement of Eye Pressure

Elevated intraocular pressure can occur when blood blocks the eye’s drainage system.

Monitoring eye pressure is especially important in patients with sickle cell disease or sickle cell trait.

Dilated Examination

Once it is safe to do so, the eye and retina may be examined for additional injuries.

Imaging Studies

If significant trauma has occurred, imaging such as CT scanning may be recommended to evaluate for orbital fractures or other injuries.

How Is Hyphema Treated?

Treatment depends on the severity of the bleeding and whether complications develop.

Activity Restriction

Patients are often advised to:

Limit strenuous activity
Avoid heavy lifting
Sleep with the head elevated
Avoid bending over excessively

Protective Eye Shield

An eye shield may be recommended to protect the eye from further injury.

Medications

Treatment may include:

Steroid eye drops to reduce inflammation
Dilating eye drops to improve comfort and prevent complications
Eye pressure-lowering medications if needed

Avoid Certain Medications

Unless directed otherwise by your physician, patients are often advised to avoid medications that increase bleeding risk, such as:

Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs)

Always consult your healthcare provider before stopping prescribed medications.

Monitoring for Rebleeding

The risk of recurrent bleeding is highest during the first week after injury.

Close follow-up examinations are essential during this period.

Surgery

Surgical removal of blood may be necessary if:

Eye pressure remains dangerously elevated
Corneal blood staining develops
The hyphema does not clear adequately
Severe rebleeding occurs

Possible Complications

Potential complications include:

Increased intraocular pressure
Secondary glaucoma
Rebleeding
Corneal blood staining
Optic nerve damage
Peripheral anterior synechiae
Permanent vision loss

Patients with sickle cell disease or sickle cell trait are at increased risk of pressure-related complications.

What Is the Prognosis?

Most uncomplicated hyphemas resolve successfully with appropriate treatment and monitoring.

The prognosis depends on:

The severity of the initial injury
The amount of bleeding
Whether complications develop
How quickly treatment is initiated

Many patients recover excellent vision, especially when no additional eye injuries are present.

Living With a Hyphema

If you have been diagnosed with a hyphema:

Keep all follow-up appointments.
Use medications exactly as prescribed.
Wear your protective eye shield if instructed.
Avoid strenuous activities until cleared by your physician.
Seek immediate care if vision worsens or pain increases.
Inform your doctor if you have sickle cell disease, sickle cell trait, or take blood thinners.

Prompt communication with your eye care team can help prevent complications.

Frequently Asked Questions

Will the blood in my eye go away?

In most cases, yes. The body gradually reabsorbs the blood over days to weeks, although close monitoring is important.

Can I go back to sports right away?

No. Physical activity restrictions are often recommended until the hyphema has resolved and your doctor determines it is safe to resume normal activities.

Is a hyphema an emergency?

Yes. Any visible blood inside the front of the eye should be evaluated promptly because complications can threaten vision.

More Information

For additional patient information, visit the American Academy of Ophthalmology (AAO) Hyphema Page