A hyphema is blood that collects in the anterior chamber, the space between the cornea and the iris, usually after blunt eye trauma. It can raise eye pressure and rebleed in the first days, so close follow-up is needed.
Key symptoms
- Blurred vision after a blow to the eye
- Eye pain and sensitivity to light
- Reddish tint or a visible layer of blood in the eye
- Nausea or headache if eye pressure is high
What you find on exam
- Blood layering at the bottom of the anterior chamber with the patient upright
- Visual acuity and pupil reactions
- Eye pressure measured only after globe rupture is ruled out
- Look for other injuries: globe rupture, orbital fracture
Tests
- CT of the orbits if globe rupture or fracture is possible
- Sickle cell screening in at-risk patients
- Coagulation tests if on anticoagulants or with a bleeding disorder
Treatment basics
- Head of bed raised 30 to 45 degrees and quiet rest
- Eye shield; avoid aspirin and NSAIDs
- Cycloplegic and steroid drops as directed by ophthalmology
- Treat high pressure with drops such as timolol
- Daily ophthalmology checks in the first days
Red flags
- Rebleeding, usually in the first 3 to 5 days
- Eye pressure that stays high, especially with sickle cell disease
- Blood filling the whole chamber or vision getting worse
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.