Hyphema: Symptoms, Causes, Classification, Treatment and Prevention


A hyphema is a bleeding or broken blood vessel inside the eye that causes blood to accumulate in the anterior chamber of the eye, the space between the cornea and the iris that is normally filled with a clear liquid called aqueous humor.

The severity of a hyphema is classified according to the amount of blood that accumulates in the eye:

Let’s see the classification:

  • Grade 0: no visible blood accumulation is observed, but red blood cells can be seen inside the anterior chamber after a microscopic examination.
  • Grade 1: accumulation of blood in less than the lower third of the anterior chamber.
  • Grade 2: Blood that fills one third to one half of the anterior chamber.
  • Grade 3: Blood that fills half of the entire anterior chamber.
  • Grade 4: total filling of the anterior chamber with blood. If the blood is bright red, this is called total hyphema. If it is dark red-black blood, it is sometimes called “8-ball hyphema”.

In general, the greater the degree of hyphema, the greater the risk of vision loss and long-term damage to the eye.

The dark red or black color of an 8-ball hyphema (the most dangerous type) is associated with a decrease in the circulation of aqueous humor and a decrease in oxygen in the anterior chamber of the eye.


In addition to the blood in the eye, the following symptoms are usually associated with hyphema:

  • Blurred or distorted vision
  • Eye pain
  • Sensitivity to light (photophobia)
  • Headache

It is especially likely that there is pain in the eyes, sensitivity to light and headache if a hyphema is causing an increase in intraocular pressure.

What causes bleeding in the eye?

The most common cause of hyphema is eye trauma. That is why it is important to consult your eye doctor immediately if you suffer an injury that causes a “black eye”.

In some cases, a traumatic hyphema can also occur after eye surgery, including cataract surgery. Although this is relatively rare.

It is also possible for a hyphema to occur spontaneously, particularly between people who take anticoagulants (such as aspirin) or who have a blood clotting disorder (hemophilia).

Diabetes can also increase the risk of a spontaneous hyphema, as can tumor growth in the eye (ocular melanoma).

Is it a serious hyphema? Are there complications?

Usually, blood that accumulates in the anterior chamber of the eye due to a hyphema will be reabsorbed by the body without permanent damage to the eye.

But in some cases, the coagulation of this blood will obstruct or damage the structure in the periphery of the anterior chamber that controls the normal output of the aqueous humor of the eye.

This can cause an increase in eye pressure that can lead to glaucoma and permanent loss of vision.

In addition, in some cases, you may bleed inside the eye after the initial eye injury that causes a traumatic hyphema. This new bleeding (which usually occurs within a few days after the injury) can be more serious and more dangerous than the initial bleeding.

People with sickle cell anemia (a hereditary disease in which red blood cells are increasingly distorted) or those who simply have the genetic trait of this disease are at greater risk of eye damage from a hyphema.


Depending on the severity of a hyphema and the associated risk factors, your ophthalmologist may recommend a combination of the following precautions and treatments:

  • Limited physical activity
  • Elevation of the head
  • Use of an eye protector
  • Frequent follow-up visits for a few weeks or months
  • Medicine for pain
  • Anti-inflammatory medicine (topical or oral)
  • In the case of a severe hyphema, surgery may be required.

Do not use over-the-counter pain relievers that contain aspirin or nonsteroidal anti-inflammatory medications if you have a hyphema, as these medications can increase the risk of rebleeding in the eye.

Even if your eye feels good and you do not notice vision problems, consult an eye doctor immediately if you have a trauma to the eyes that could cause a hyphema. Be sure to attend all follow-up visits that your doctor recommends.

In addition, routine eye exams are very important after having a hyphema, since your risk of high eye pressure and glaucoma may be even greater years later.

How can I prevent a hyphema?

The best way to avoid a traumatic hyphema is to wear safety glasses or other protective goggles whenever you are involved in potentially dangerous activities.

Sports goggles should be worn when playing baseball, softball, soccer, basketball, hockey or other sports that pose a risk of eye trauma.

Also, keep in mind that sports like boxing significantly increase the risk of a traumatic hyphema.

And if you participate in paintball games, wear a protective helmet that includes a clear, impact-resistant shield that completely protects your face and eyes.