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Bloody eye!

Hyphema : Accumulation of red blood cells within the anterior chamber

Etiology :

  • Blunt/lacerating trauma

  • Intraocular surgery

  • Post Nd: YAG laser for PI

  • Blood dyscrasias (aplastic anemia, leukemia etc)

  • Use of substances that alter platelet or thrombin function

  • Strenuous conditions (asthma, whooping cough)

  • Spontaneously (rubeosis iridis in vein occlusions/ Diabetic retinopathy, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, herpes zoster keratouveitis, retinoblastoma)


Grade 0: No visible layering, but red blood cells within the anterior chamber (microhyphema) 

Grade I: Less than 1/3rd of anterior chamber

Grade II: 1/3 rd to ½

Grade III: 1/2 to less than total

Grade IV: Total filling of the anterior chamber with blood.

8 ball Hyphema

If the anterior chamber is filled with dark red-black blood it is called a blackball or 8-ball hyphema. The black color is suggestive of impaired aqueous circulation and decreased oxygen concentration. This distinction is important because an eight ball hyphema is more likely to cause pupillary block and secondary angle closure.

Surgical management (AC paracentesis with irrigation and aspiration) indications:

  • Corneal blood staining

  • Significant visual deteoriation

  • To prevent optic atrophy (IOP > 60mmHg for >48 hours despite max medical therapy)

  • To prevent PAS (Hyphema <50% for 8 days)

  • IOP >25mmHg with total hyphema >5 days

  • IOP >24mmHg for >24 hours (or transient IOP >30mmHg) in patients with sickle cell disease/ trait

Image from Rajan Eye Care Hospital

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