Hyphema

Hyphema (hi-FEE-ma) is a collection of blood inside the front of the eye. The blood may cover all or part of the iris (the colored part of the eye) and the pupil (the black circle of the eye). It usually heals without problems but can cause loss of vision if it is not properly managed. You can lose vision because the eye pressure can get very high. The blood may look like a black spot or area covering the iris.

Cause

Hyphema is usually caused by blunt trauma (a hard hit) to the eye.

Risks

Risks include:

• Sports where a ball or puck is hit or thrown, such as baseball, hockey or lacrosse.
• Contact sports where the eye can be hit by another person’s elbow or hand, such as basketball.
• Projectiles from toy, like darts, nerf guns and bows and arrows.

Signs and Symptoms

• blood in the front of the eye
• light sensitivity
• pain in the eye
• blurry or blocked vision
• irregular shape of the pupil or different size between the two eyes

Diagnosis

A complete eye exam by an eye doctor is needed to diagnose a hyphema. A complete eye exam includes checking visual acuity (how well your child sees at various distances). The exam will monitor how much blood there is inside the eye and how fast it is reabsorbed. It is very important to monitor the eye pressure. This is why a child needs to be seen each day until the risk to their vision is gone.

Treatment

• During an emergency room visit, your child should expect to have a complete eye exam by an ophthalmologist. It will include having both vision and pressure in their eyes checked.
• It is important to protect your child’s injured eye by having them wear an eye shield.
• They should not participate in physical activity until their eye doctor says it is okay.
• Frequent follow-up appointments with your child’s eye doctor are important to monitor healing and prevent vision loss.

What to do at Home

• Have your child sit or lie quietly with their head elevated around 45 degrees.
• Your child needs to wear an eye shield all the time.
• Avoid medicines that contain aspirin, such as ibuprofen (Motrin®).
• Continue with normal hygiene.
• Give medicine only as directed by your child’s eye doctor.

Activity and Diet

Your child should NOT participate in physical activity until approved by the doctor. They can continue to eat their regular diet.

What to Look For

Your child should tell you if they see flashing lights or floaters (small black specks) in their field of vision.

When to Call The Doctor

If any of the follow occurs, call your child’s eye doctor for advice:

• worsening pain
• worsening vision
• nausea or vomiting
• headache
• eye redness

Follow-up Appointments

You can expect your child to have regular follow-up appointments with their eye doctor. These appointments can be every day for the first week. Be sure to call the doctor if you cannot keep an appointment.

Write out your questions as you think of them. Bring the list when you see the eye doctor.

Hyphema (PDF)

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