Hyphema occurs when there is a collection of blood in the anterior chamber of the eye--behind the cornea and in front of the iris. The hyphema might be noticeable by the patient when looking in the mirror or it could be too small to see without ophthalmic equipment. This condition requires immediate evaluation by an eye doctor because if it is not managed appropriately, vision loss could result. One reason for this is that the blood in the anterior chamber could block the drainage angle of the eye causing elevated eye pressure. Hyphemas can be caused by a variety of reasons, all stemming from bleeding of the blood vessels on or in the iris.
Trauma
Trauma to the eye is the most common cause of hyphema. Trauma can include punches, falls, car crashes, or sports injuries. Although there may not be any obvious injury to the eye after this type of trauma, the patient should have the eye evaluated by an eye doctor. The eye doctor may need to treat and monitor any hyphema to prevent any further eye problems.
Surgical Procedures
After any ocular surgery where the ophthalmologist works inside of the eye, for example, cataract surgery or corneal transplant, a patient may develop a hyphema. In these cases, the eye surgeon will monitor the patient closely after the surgical procedure with more frequent office visits and pressure checks.
Neovascularization
Some eye diseases cause new blood vessels to form on the iris, known as neovascularization. These new blood vessels are weaker than normal blood vessels, and can break and bleed into the eye causing a hyphema. The condition that caused the neovascularization needs to be treated; besides bleeding, neovascularization can lead to glaucoma or other problems in the back of the eye.
Cancer
Different types of cancers can cause hyphema in the eye. Blood cancers such as chronic lymphocytic leukemia or a tumor in the eye may cause a hyphema. However, as noted in the book, Neurologic Complications of Cancer, authors Lisa M. DeAngelis and Jerome B. Posner report that metastases to the eye from cancers that originated in other parts of the body may also cause a hyphema. When a hyphema occurs in a patient with no recent history of trauma or surgery, the doctor should further investigate the cause of the bleeding in the eye.
Systemic Blood Disorders
Systemic blood disorders problems can increase the risk of hyphema. Patients with sickle cell anemia, von Willebrand's disease, or hemophilia can all develop hyphemas as a result of the disease. If a patient presents with a hyphema with no precipitating factors, a work-up including possible blood disorders would be important.
References
- PDR Health: Hyphema
- St. Luke's Cataract and Laser Institute: Hyphema
- AAPOS: Hyphema
- "Neurologic Complications of Cancer"; DeAngelis LM and Posner JM; 2009.
- Handbook of Ocular Disease Management: Hyphema
