Hyphema is a condition where blood collects in the anterior chamber of the eye, between the cornea (the clear membrane) and the iris (the rainbow membrane). Blood may partially or completely cover the iris and pupil (black circles in the eye).
Hyphema usually occurs due to injury or trauma that causes the iris or pupil of the eye to tear. Bleeding in the hyphema is accompanied by pain, in contrast to bleeding in the thin layer of the conjunctiva (white part of the eye) which is not accompanied by pain.
Hyphema can cover half or all of the vision. Therefore, patients with hyphema should receive medical attention immediately, so as not to experience damage to their eyesight or even blindness.
Based on the amount of blood that fills the chambers of the eye, hyphema can be divided into 4 levels, namely:
- Grade 1: blood fills less than a third of the anterior chamber of the eye
- Level 2: blood fills one-third to one-half of the anterior chamber of the eye
- Grade 3: blood fills more than half of the anterior chamber of the eye
- Grade 4: blood fills the entire anterior chamber
In addition to these 4 levels, there is also what is called a microhyphema, which is a condition when bleeding in the chambers of the eye can only be seen through an examination by a doctor.
Causes of Hyphema
Based on the cause, hyphema can be divided into two types, namely:
Traumatic hyphema
Traumatic hyphema caused by injury to the eye. This condition occurs when the eye is impacted, for example due to sports or fights. Injuries can also occur as a result of a fall or accident.
In most of the cases, traumatic hyphema experienced by boys aged 10-20 years when they play sports or activities.
Spontaneous hyphema
Spontaneous hyphema is a hyphema that occurs as a result of a medical condition, such as:
- Abnormal blood vessel formation (neovascularization) due to diabetic retinopathy or ischemia
- Melanoma eye cancer
- eye tumor
- Leukemia
- Inflammation of the middle layer of the eye (uveitis)
- Blood clotting disorders, such as hemophilia and Von Willebrand's disease
- Eye infection due to herpes virus
- Postoperative complications of the eye, such as scratching the iris during lens implants
- History of eye surgery
- Blood disorders, such as thalassemia
- Sickle cell anemia
Symptoms of Hyphema
Symptoms and signs of a hyphema depend on its severity. Some of these signs and symptoms are:
- Blood in the eye
- Eyes sensitive to light (photophobia)
- Increased pressure in the eyeball
- Blurred or obstructed vision
- Eyes hurt
In mild hyphema, blood in the eye can only be seen through an eye examination by a doctor. However, in severe hyphema, the eye may appear as if it is filled with blood.
When to go to the doctor
Hyphema is an emergency. Therefore, immediately consult an ophthalmologist if you experience the above symptoms, especially if your eye has previously experienced a collision or injury.
Hyphema Diagnosis
To make a diagnosis, the ophthalmologist will ask the patient about a history of eye injuries, a history of eye surgery, and the patient's overall medical history. The doctor will also perform a number of follow-up examinations below to confirm the diagnosis:
- Visual acuity test
- Examination of the inside of the eye using slit lamp
- Tonometry or measurement of the pressure inside the eyeball
- Examination of the condition of the inside of the eyeball with a CT scan
In addition to the above checks, your doctor may also order blood tests to detect sickle cell anemia or other conditions that can increase your risk of hyphema complications.
Hyphema Treatment
Hyphema treatment will be adjusted according to the severity of the patient's condition. In patients with mild hyphema, treatments that can be given by doctors include:
- Advise the patient to rest completely or bed rest with the head position slightly higher than the body position when lying down
- Instruct the patient to wear an eye patch on the eye affected by the hyphema and not to do activities that make the eyes move a lot, such as reading
- Prescribe paracetamol (to relieve pain), atropine eye drops (to dilate the pupil of the eye), and corticosteroid eye drops (to prevent and reduce inflammation of the eye)
- Prescribing anti-vomiting medication, as vomiting can increase eye pressure
- Prescribing beta-blocking drugs, if the pressure in the eye increases
Keep in mind, avoid taking painkillers that contain aspirin because it can aggravate bleeding. Patients are also not advised to take non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen.
In patients with severe hyphema and mild hyphema that is getting worse, the doctor will perform the following treatment methods:
- Anterior chamber washout, which is an action to remove blood in the eye by rinsing the inside of the eye using a special liquid
- Anterior chamber fluid-gas exchange, which is an action to remove blood in the eye using gases and liquids
- Vitrectomy, which is an action to remove blood clots in the eye using a special tool
- Trabeculectomy, which is a procedure to reduce pressure in the eyeball through making an incision in the eye
- Iridectomy, which is a procedure to reduce pressure on the eyeball by removing part of the iris of the eye
KHyphema complications
Patients with hyphema generally recover completely. However, in severe cases, sufferers can experience complications, such as:
- Repeated bleeding
- Cornea stained with blood
- Glaucoma
- Blindness
Hyphema Prevention
The best way to prevent a hyphema is to avoid conditions that can cause injury to the eye. One of them is by wearing eye protection when doing activities that risk causing eye injury, such as during sports.
Another way to prevent a hyphema is to have your eye checked regularly, especially if you've had an eye injury recently, even if it's not bleeding.
