Seeing excess blood in your eyeball is jarring and a little scary. We instinctively know our eyes are delicate and complex, so we cringe away from the idea that there could be something wrong with them. For the most part, the appearance of a little bit of blood in the white of your eye is due to a burst blood vessel. This is called a subconjunctival hemorrhage and it’s nothing to be concerned about.
But the other kind of bleeding in the eye, hyphema, is far from harmless. Therefore, it’s important to know the symptoms, causes, and what to do if it happens to you.
A hyphema occurs when blood starts to fill the space between your iris and cornea (the anterior chamber). This space is normally filled with a clear fluid called the aqueous humour.
Hyphemas are classified in grades based on how much blood has emptied into the anterior chamber.
Grade 0 hyphema (also called a microhyphema) shows no blood to the naked eye, but blood can be seen in the anterior chamber through a microscope.
Grade 1 hyphema indicates blood in the lower third of the anterior chamber.
Grade 2 hyphema involves blood filling between a third and half of the anterior chamber.
Grade 3 hyphema means the blood has filled over half the anterior chamber, but has not filled it up completely.
Grade 4 hyphema is also called a total hyphema if the blood appears bright red, or an 8 ball hyphema if the blood appears quite dark or black. In this case, blood has completely filled the anterior chamber.
The higher the grade of the hyphema, the more likely the patient is to sustain permanent damage or vision loss in that eye. An 8 ball hyphema (when the anterior chamber is completely filled with dark blood) is particularly dangerous, as it indicates decreased circulation and oxygen in the eye.
More often than not, a hyphema is the result of sports, roughhousing, or any kind of blunt force trauma to the eye. Although it’s uncommon, a spontaneous hyphema can occur, particularly among those with blood clotting disorders, eye tumors, diabetes, or those taking blood thinners. Hyphemas also sometimes happen as a complication of cataract surgery.
A hyphema is usually quite painful. Aside from the obvious blood in your eye, you’re likely to experience headaches, sensitivity to light, and unclear vision.
In most cases, the blood will reabsorb into the eye. Sometimes however, the blood clots, clogging the anterior chamber, potentially damaging the structure and restricting the aqueous humour from draining properly. The resulting intraocular eye pressure can cause glaucoma and potentially lead to irreversible vision loss.
Sometimes the eye begins bleeding again a few days after the injury. The process of “rebleeding” can actually be even more damaging than the original injury, so it’s important to see a doctor, even if your eye feels alright.
You should not try to treat a hyphema on your own. Your doctor needs to assess your condition, and ensure that your vision is not at risk. Always seek medical attention if you suspect you have a hyphema. Your doctor may prescribe medication to relieve the pain. It’s crucial that you do not take any over the counter pain medication, or other pain medications that were not prescribed to you as they could increase the risk of rebleeding.
You should try to sleep with your head elevated and avoid strenuous exercise for a few weeks. Follow all of your doctor’s instructions closely, and keep any follow up appointments. Failing to follow the instructions for recovery could have permanent effects on your vision.