This is bleeding inside the eye, occurring after trauma or spontaneously from neovascularization (abnormal blood vessels inside the eye).  With a hyphema, blood leaks from internal blood vessels and pools in the front part of the eye (the anterior chamber). If there is enough blood, gravity causes the blood to sink into a visible ‘layer.’  A hyphema is easy to see under a microscope and can sometimes be detected with the naked eye.  This is contrast to a vitreous hemorrhage in the back of the eye that can only be detected during a dilated eye exam.  Blood cells can clog the aqueous “drain” and cause a temporary glaucoma, so treatment is geared toward lowering the eye pressure with glaucoma eye drops.  Steroid drops are also used to decrease inflammation. Occasionally, dilating drops are used for pain control (a process called cycloplegia) and to keep the pupil edge from scarring down and forming iris synechiae.  Hyphema bleeding usually occurs from a leaking blood vessel in the iris. A clot will form to stop this bleeding.  After three to five days, however, this clot begins to break down and the eye is at risk for a ‘rebleed.’  For this reason, we will typically check the eye several times during the first week to monitor pressure and hyphema status.  Anyone with enough trauma to cause a hyphema is at risk for developing chronic open angle glaucoma secondary to microscopic damage to the trabecular meshwork drain.  After the eye has healed, we may look at this drain via gonioscopy to see if there is any obvious damage that can be seen.

Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:


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