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Hyphaema (bleeding in eye)

Trauma to the eye can cause bleeding in the front compartment (or anterior chamber) of the eye that is situated between the cornea (the front clear part of the eye) and the iris (the coloured disc surrounding the pupil). Bleeding into the anterior chamber of the eye is called a hyphaema. The anterior chamber of the eye contains a clear liquid fluid called aqueous humour. The aqueous humour is secreted by the ciliary processes in the posterior chamber of the eye. The aqueous humour passes through the pupil into the anterior chamber.

Hyphaema causes

Trauma to the eye may initially cause a small hyphaema. More severe bleeding may follow in 3-5 days. This trauma is usually blunt or closed trauma, and it may be the result of an athletic injury from a flying object, a stick, a ball, or another player's elbow. Other causes include industrial accidents, falls, and fights.

Hyphaema symptoms

A person with a hyphaema usually has had a recent incident of eye trauma, might feel pain in the injured eye, and may have blurred vision.

If the hyphaema is large, the eye itself may look as if it is filled with blood. Smaller hyphaemas are not readily visible to the naked eye.

When to seek medical care

Any hyphaema needs urgent medical advice. You can call your GP for an urgent appointment or you can go straight to your local general hospital A&E. The eye (ophthalmology) departments in most large NHS general hospitals have a dedicated Accident and Emergency department for eye injuries.

If you cannot see your GP quickly, go to a hospital's A&E department.

Questions to ask the doctor

  • What is the size of the hyphaema?
  • Are there any signs of permanent damage to the eye?
  • Are there any signs of permanent loss of vision?
  • How can I prevent this injury from happening again?
  • When may I resume my regular activities?

Examinations and tests

If you see an ophthalmologist (eye specialist), he or she will ask about any history of eye injury, when the injury may have happened, and how it happened. It is important for the ophthalmologist to know if, for example, you were hit in the eye with a bat or you ran into a low-hanging branch on a tree.

  • A complete eye examination is performed.
  • A visual acuity test checks for how well you can see. The intraocular pressure (pressure inside the eye) must be checked.
  • A special microscope, called a slit lamp, is used to look inside the structures of the eye.
    • A hyphaema can be seen as a clot or layered blood in the anterior chamber of the eye. If the entire anterior chamber is filled with blood, it is sometimes referred to as a “black ball” hyphaema. Smaller hyphaemas may appear layered in the anterior chamber.
    • A micro-hyphaema may also be seen. This appears as a haziness of suspended red blood cells in the anterior chamber.
  • If you have experienced severe trauma, the doctor may order X-rays or a CT scan to look at the eye sockets themselves and other facial structures, and to exclude the presence of any debris or a foreign body in or around the eye.
  • People of African and Mediterranean descent should be screened for sickle cell disease or thalassaemia, which can lead to serious complications. In these cases, surgery may be considered as an early option.
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