What is a hyphaema?

A hyphaema is bleeding in the front part of the eye. It is most commonly due to trauma (injury) and can therefore be associated with damage to other structures of the eye.

Images of a normal eye and one with Hyphaema (bleeding)
Images of a normal eye and one with Hyphaema (bleeding)

Source: Relay Health 2014

What are the symptoms of a hyphaema?

  • Pain
  • Blurred vision
  • Enlarged pupil

What is the treatment of a hyphaema?

  • Physical activity must be limited to allow the eye to heal and decrease the risk of recurrent bleeding. Bed rest is recommended with quiet, light activity around the home for one to two weeks. No strenuous activity (eg sports) until approved by the doctor. Do not rub or put pressure on the eye.
  • Sleep with a plastic eye shield taped over the eye until the bleeding resolves (blood is gone).
  • Consider sleeping with an extra pillow or elevate the head of the bed to allow the blood to settle.
  • Eye drops:
    • Steroid eye drops to decrease the inflammation in the eye associated with the blood.
    • Dilating drops to immobilize the iris and decrease the risk of recurrent bleeding.
  • Paracetamol for pain relief.
  • Avoid blood thinning medications such as aspirin and anti-inflammatory drugs for pain. If you are on these or other blood thinning medications, please inform the doctor to see if it is necessary and safe to temporarily discontinue the medication.

What are the possible complications of a hyphaema?

  • Recurrent bleeding – this usually occurs at three to five days after the injury. This may result in a hyphaema which is larger and more difficult to treat than the initial bleeding.
  • Elevated eye pressure. If untreated it can lead to permanent loss of vision.
  • Unrecognised eye damage due to difficulty seeing the back of the eye from the blood. Once the blood settles, you will need a complete eye examination to look for other possible injuries:
    • Damage to the drainage channels in the front of the eye which can be associated with a future risk of elevated eye pressure and glaucoma.
    • Damage to the retina (lining of the posterior part of the eye) such as a retinal hole, tear or detachment.
    • Bleeding into the vitreous (‘jelly’ at the back of the eye).

Things to remember

  • Contact your eye specialist or the Eye and Ear Emergency Department immediately if you have worsening vision, flashing lights/floaters in your vision, or eye pain not relieved by paracetamol.
  • Follow instructions for limited physical activity to decrease the risk of recurrent bleeding which is highest from 3 to 5 days after the injury.
  • You will need an annual eye check because of potential risk of future glaucoma and other eye problems.

More information

If you are concerned that your eye condition is not improving or is getting worse please contact your GP or visit the Emergency Department at the Eye and Ear.

References: http://www.summitmedicalgroup.com/library/adult_health/oph_hyphema/ 

Disclaimer This document describes the generally accepted practice at the time of publication only. It is only a summary of clinical knowledge regarding this area. The Royal Victorian Eye and Ear Hospital makes no warranty, express or implied, that the information contained in this document is comprehensive. They accept no responsibility for any consequence arising from inappropriate application of this information.

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  • Hyphaema #24
  • Owner: Emergency Department
  • Last Reviewed: April 14, 2018
  • Next Review: April 14, 2023