II. Definition

  1. Bleeding in the anterior chamber of the eye

III. Causes

  1. Blunt Eye Injury (most common)
    1. Injury to the iris root (outer edge of the iris where it meets the Sclera)
    2. Subsequent bleeding arises from the iris blood vessels
  2. Post-surgical
  3. Spontaneous bleeding without injury history
    1. Leukemia
    2. Lymphoma
    3. Child Abuse

IV. Exam

  1. Determine amount of bleeding (height of Hyphema)
    1. Total Hyphema (8 ball Hyphema) completely obscures pupil
  2. Evaluate for Globe Rupture
  3. Intraocular Pressure
    1. High pressure suggests blood clogging the trabecular drainage

V. Labs

  1. Sickle Cell preparation in non-caucasian patients
    1. Perform even in Traumatic cases (this is emphasized by ophthalmologists)
    2. Significantly worse outcomes (even for Sickle Cell Trait)

VI. Complications

  1. Blindness
    1. Results from Hyphema rebleeding (from dislodged clot)
  2. Corneal blood staining
  3. Glaucoma

VII. Prognosis

  1. Worse prognosis in Sickle Cell Anemia

VIII. Management

  1. Restrict movement
    1. Bed rest with head of bed at 30 degrees
    2. No reading
    3. Avoid pressure on eye (risks dislodged clot and rebleeding)
  2. Fox metal shield (or small paper cup) to cover injured eye
    1. Prevents further Eye Injury
  3. Immediate Referral to Ophthalmology
  4. Consider inpatient management
    1. Systemic aminocaproic acid (AMICAR)
  5. Outpatient management
    1. Topical Corticosteroids
      1. Consider in Consultation with ophthalmology
    2. Atropine 1% single dose
      1. Results in complete paralysis of the iris muscle for 2 weeks
      2. Other Cycloplegics do not completely paralyze the iris and require frequent re-dosing
    3. Glaucoma agent (if Intraocular Pressure increased)
      1. Intraocular Beta Blocker (e.g. Timolol) - Preferred first-line agent
      2. Intraocular Carbonic Anhydrase Inhibitor (Trusopt, Azopt)
      3. Intraocular Alpha-2 Adrenergic Agonist (Lopidine, Alphagan)

IX. Management: Sickle Cell Anemia

  1. Requires emergent management
    1. Risk of Eye vaso-Occlusion
    2. Risk of acute angle closure Glaucoma
    3. Risk of Vision Loss
  2. Admit all Sickle Cell Anemia patients with Hyphema (even small Hyphemas)
  3. Raise head of bed
  4. Consult ophthalmology
  5. Agents that may be used in Sickle Cell Disease and Hyphema
    1. Beta Blockers
    2. Clonidine
  6. Avoid medications in Sickle Cell Disease that cause sickling
    1. Acetazolamide (Diamox)
    2. Diuretics
    3. Mannitol
    4. Topical beta agonists (e.g. Epinephrine)

X. References

  1. Majoewsky (2012) EM:Rap 12(1): 4
  2. Glassberg and Weingart in Majoewsky (2012) EM:Rap 12(9): 3-4

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Ontology: Hyphema (C0020581)

Definition (NCI) Hemorrhage within the anterior chamber of the eye; bloodshot.
Definition (NCI_FDA) Hemorrhage within the anterior chamber of the eye; bloodshot.
Definition (MSH) Bleeding in the anterior chamber of the eye.
Concepts Pathologic Function (T046)
MSH D006988
ICD10 H21.0 , H21.00
SnomedCT 193502002, 267720002, 75229002
LNC LA17283-5
English Hyphemas, HAEMORRHAGE ANT CHAMBER EYE, HEMORRHAGE ANT CHAMBER EYE, Hyphema, Hemorrhage ant chamber eye, Haemorrhage ant chamber eye, hyphema (diagnosis), hyphema (physical finding), hyphema, anterior chamber hyphema, Anterior eye chamber haemorrhage, Anterior eye chamber hemorrhage, Hemorrhage of anterior chamber of eye, Hyphema, unspecified eye, Hyphema [Disease/Finding], hyphaemia, blood in anterior chamber, hyphemia, Haemorrhage of anterior chamber of eye, Hyphaema (disorder), HYPHEMA, Hyphemia, Blood in anterior chamber, Hyphaema, Hyphaemia, Hyphema (disorder), eye; hemorrhage, anterior chamber, hemorrhage; eye, anterior chamber, hyphaema
French HYPHEMA, Hémorragie de la chambre antérieure de l'oeil, Hyphème, HEMORRAGIE CHAMBRE ANTER OEIL, Hyphéma, Hémorragie dans la chambre antérieure de l'oeil
Portuguese HIFEMA, Hemorragia da câmara anterior do olho, HEMORRAGIA DA CAMARA ANT DO OLHO, Hifema
Spanish HIPEMA, Hemorragia de la cámara anterior del ojo, HEMORRAGIA CAMARA ANTERIOR OJO, hifema (trastorno), hifema, sangre en cámara anterior, Hifema, Hipema
Dutch hemorragie voorste oogkamer, hemorragie van voorste oogkamer, bloeding van voorste oogkamer, bloeding; oog, voorste oogkamer, oog; bloeding, voorste oogkamer, hyphaema, Bloeding; corpus; ciliare, Bloeding; voorste oogkamer, Hyphaema
German Vorderaugenkammer, Blutung, Blutung der vorderen Kammer des Auges, Blutung, Vordkamm Auge, BLUTUNG AUGENVORDERKAMMER, HYPHEM, Hyphaema
Italian Emorragia della camera anteriore dell'occhio, Ifema
Japanese 前房出血, ゼンボウシュッケツ
Swedish Hyphema
Czech krvácení do přední komory oční, hyphéma, Krvácení do přední komory oční, Hemoragie přední komory oční, Hyphema
Finnish Hyfeema
Korean 전방출혈
Croatian HIFEMA
Polish Krwiak komory przedniej
Hungarian Elülső szemcsarnok vérzés, Elülső szemcsarnok vérzése, Hyphaema, Hyphema
Norwegian Hyfema