Eye and Cranial Complications - Hyphema
Introduction
Hyphema is blood in the anterior chamber of the eye. It most commonly follows blunt orbital or facial trauma but may also result from penetrating injury, intraocular procedures, spontaneous ocular bleeding in coagulopathy, or ocular vascular disease.
Hyphema can threaten vision via raised intraocular pressure (IOP), corneal blood staining, secondary glaucoma, or optic nerve injury. It may coexist with life‑ or sight‑threatening cranial or orbital injuries.
Most cases are managed conservatively in the emergency department with early ophthalmology follow‑up; a minority require urgent surgical intervention (historically ~5%) (NICE IPG/HTG).
Mechanism and risk factors
- Blunt trauma (assault, falls, sports injuries, fireworks, blast) causes rupture of iris or ciliary body vessels.
- Penetrating injury, intraocular surgery, or intraocular foreign body can produce hyphema.
- Systemic factors that increase bleeding or impair clotting include anticoagulant or antiplatelet therapy, haemophilia, and von Willebrand disease.
- Ocular comorbidities that raise complication risk include pre‑existing glaucoma, sickle cell disease, and diabetic eye disease.
Clinical presentation Typical features:
- Reduced or blurred vision and a visible red or brown fluid level in the anterior chamber; the hyphema may be microscopic and not visible without slit lamp examination.
- Eye pain and photophobia that are often from associated traumatic iritis or raised IOP.