Hyphaema of the Eye

Definition

Hyphaema is the presence of blood in the anterior chamber of the eye, between the cornea and the iris. It usually results from trauma and can lead to increased intraocular pressure and potential vision loss if not managed promptly.

Aetiology

Hyphaema can be caused by various factors, including:

Blunt or penetrating trauma to the eye
Post-surgical complications
Blood disorders, such as haemophilia or sickle cell anaemia
Intraocular tumours

Pathophysiology

Trauma or other causes can lead to a rupture of the blood vessels in the iris or ciliary body, resulting in bleeding into the anterior chamber. The presence of blood can block the trabecular meshwork, impeding aqueous humour outflow and increasing intraocular pressure. This can lead to further complications such as optic nerve damage and vision loss.

Risk Factors

Participation in contact sports
Lack of protective eyewear during high-risk activities
Pre-existing blood disorders
Previous eye surgery
Ocular trauma

Signs and Symptoms

Common signs and symptoms of hyphaema include:

Visible blood in the anterior chamber
Eye pain
Blurred vision
Photophobia (sensitivity to light)
Decreased visual acuity
Increased intraocular pressure

Investigations

Clinical history and physical examination
Visual acuity testing
Slit-lamp examination to assess the extent of the hyphaema
Tonometry to measure intraocular pressure
Ocular ultrasound if the view of the posterior segment is obscured
Blood tests to assess clotting function and rule out underlying blood disorders

Management

Primary Care Management

Immediate referral to an ophthalmologist: For further evaluation and management
Initial care:
- Advise the patient to avoid any activities that could increase intraocular pressure, such as bending over or lifting heavy objects
- Recommend elevating the head of the bed to 30 degrees to help blood settle inferiorly
- Administer analgesics for pain relief

Specialist Management

Medical management: Includes topical corticosteroids to reduce inflammation and cycloplegic agents to relieve pain and prevent further bleeding
Intraocular pressure control: Using medications such as beta-blockers, alpha agonists, or carbonic anhydrase inhibitors
Surgical intervention: If there is a large or non-resolving hyphaema, or if intraocular pressure remains uncontrolled, procedures such as anterior chamber washout may be necessary
Regular follow-up to monitor intraocular pressure and ensure resolution of the hyphaema

References

Patient.info. (2024). Hyphaema of the Eye. Retrieved from Patient.info
NHS. (2023). Hyphaema. Retrieved from NHS
British Medical Journal (BMJ). (2022). Hyphaema: Diagnosis and Management. Retrieved from BMJ
American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Hyphaema. Retrieved from AAO