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Hyphema: Definition, Causes, Prevention and Treatment Conditions


While hyphema can cause vision problems and sensitivity to light, in most cases it does not cause permanent damage. Therefore, people should seek prompt treatment, which can range from medications and home remedies to more comprehensive treatment for complications that arise. When blood collects in the eye, a hyphema occurs, which can cause visual obstruction. Trauma is the most common cause of this condition. However, there are situations when people have certain medical conditions that can occur without becoming traumatized. This problem can be painful and cause vision problems, so it is important to seek emergency treatment.
Hyphema: Definition, Causes, Prevention and Treatment ConditionsThere is also a risk of serious complications if hyphema is left untreated. So there are several tests a doctor can do to make an accurate diagnosis. If the cause is trauma, it is also important to perform additional tests to look for other potential problems, such as concussion. When hyphema is correctly diagnosed, as there are treatment options, the best treatment depends on several factors such as the person’s age, how they tolerate the medications, and the severity of their injury. Because of the potential complications, it is important for everyone to take the right preventative measures. A few simple things can help reduce the risk of hyphema for most people.

What is Hyphema?

Hyphema is a health condition that causes a broken blood vessel in the eye to accumulate blood in the anterior chamber of the eye. As blood collects, it either partially or completely covers the pupil. The pupil is a black circle inside the iris, and when hyphema is present, individuals may experience partial or total obstruction in their vision. The eye injury that causes the pupil or iris to tear is often responsible for this condition. There are less common factors that can cause a hyphema and these are as follows:
Abnormal surface blood vessels on the iris,
Blood coagulation disorders,
Eye cancers (only in rare cases),
Eye infections due to herpes virus,
Artificial lens problems after cataract surgery,
It is important to note that a broken blood vessel is a separate issue called subconjunctival hemorrhage. This bleeding is usually harmless and painless. However, a hyphema often causes pain. Without prompt and appropriate treatment, hyphema can cause permanent vision problems. The space between the cornea and iris is normally filled with clear fluid. The severity of hyphema in the eye is graded according to how much blood is accumulated in the eye. This rating is as follows:
• Grade 0 (microhyphema): There is no visible blood accumulation, but red blood cells can be seen in the anterior lens in microscopic examination,
• Grade 1: Less than one third of blood accumulation in the front lens,
• 2nd degree: Blood accumulation that fills one third to half of the front lens,
• 3rd degree: Blood accumulation that fills less than half of the front lens,
• Grade 4: The front lens is completely filled with blood. If the color of the blood is bright red, this is defined as total hyphema, while dark red-black is sometimes defined as 8 balls of hyphema.
Hyphema: Definition, Causes, Prevention and Treatment ConditionsGenerally, if it is as high as the hyphema classification, the higher the risk of bleaching and vision loss in the eye in a long time. The dark red or black color of the 8 ball hyphema (the most dangerous species) is associated with reduced circulation and decreased oxygen in the anterior chamber of the clear fluid. In addition to blood in the eye, there are different symptoms of hyphema, and these are:
Blurred or impaired vision
• Eye pain,
Light sensitivity,
• Headache,
Eye pain, photosensitivity, and headache are particularly likely to occur when a hyphema causes increased intraocular pressure (IOP).

Causes of Bleeding in the Eye

The most common cause of hyphema is trauma to the eye. For this reason, it is important to see a qualified ophthalmologist immediately when you experience a black eye injury. In some cases, a traumatic hyphema may also occur after eye surgery, including cataract surgery, but this is a relatively rare occurrence. This disease is more likely to occur spontaneously, especially in people who take blood thinners such as aspirin and warfarin, or who have a blood clotting disorder such as hemophilia. In addition, diabetes can increase the risk of spontaneous hyphema, such as tumor growth in the eye (ocular melanoma).

Hyphema Severity and Complications

Mostly, the blood accumulated in the front of the eye due to hyphema is absorbed and excreted by the body without causing any permanent damage to the eye. In some cases, however, this blood clotting obstructs or damages the structure around the anterior chamber that controls the normal outflow of aqueous humor from the eye. This can cause increased eye pressure, which can lead to glaucoma and permanent vision loss. In addition, in some conditions, hyphema can be caused by a traumatic condition that causes eye injury and bleeding in the eye. While this new bleeding usually occurs a few days after the injury, it may be more severe than the first bleeding and may be risky. People with sickle cell anemia, an inherited disease in which red blood cells turn into a crescent shape, or those with a genetic trait for this disease, have an increased risk of eye damage from hyphema.

Hyphema Treatment

Depending on the severity of hyphema and associated risk factors, a combination of precautions and treatments is recommended. These recommended treatments are as follows:
• To do limited physical activities,
• Keeping the head elevated, including while sleeping,
• Wearing eye shields, such as glasses or tape,
• Visiting an ophthalmologist regularly for a few weeks or months,
• Using pain medication,
• Using topical or oral anti-inflammatory drugs,
• Regular use of other recommended medications,
Besides these treatments, surgery may be required in case of severe hyphema. If you have hyphema, over-the-counter pain medications containing aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) should never be used, as these drugs may increase the risk of re-bleeding in the eye. Even if the person feels good and does not notice vision problems, they should see an ophthalmologist immediately if there is eye trauma that may cause hyphema. Also, routine eye exams are very important after suffering hyphema, as the risk of high eye pressure and glaucoma may be higher even years later.

Preventing hyphema

The best way to avoid a traumatic hyphema is to wear safety glasses or other protective goggles when involved in potentially hazardous activities. It should also be borne in mind that sports such as boxing significantly increase the risk of traumatic hyphema. In case of participation in paintball games, protective helmets containing a transparent, impact-resistant shield that completely protects the face and eyes should be used.

Hyphema: Definition, Causes, Prevention and Treatment ConditionsEye Blood Subconjunctival Bleeding Causes and Treatment

Redness of the eye that occurs when small, delicate blood vessels under the tissue covering the white of the eye (conjunctiva) break may indicate subconjunctival hemorrhage. Subconjunctival hemorrhage is generally benign and causes no vision problems or significant eye discomfort despite its striking appearance. But eye redness can be a sign of other types of potentially serious eye conditions. If there is eye drainage, an ophthalmologist should be consulted for an eye exam to rule out infection caused by bacteria, viruses or other microorganisms. In addition, an ophthalmologist should be consulted immediately when there is an unusual or persistent redness of the eye with sudden vision change, pain, or strong light sensitivity. This type of eye redness can be a sign of other eye problems such as sudden onset glaucoma.

The Cause of Subconjunctival Hemorrhages

Although it is not always possible to identify the source of the problem, subconjunctival bleeding has some possible causes. These possible causes of bleeding are as follows:
Eye trauma,
Sudden increase in blood pressure due to heavy lifting, coughing, sneezing, laughing and constipation,
Blood thinners such as aspirin or warfarin (a brand name is Coumadin),
Rarely a blood clotting disorder or vitamin K deficiency (vitamin K helps the work of proteins necessary for blood clotting),
Eye surgery, including LASIK and cataract surgery.

Subconjunctival Bleeding Treatment

Lubricating artificial tears can soothe the eyes, but eye drops cannot help repair broken blood vessels. Aspirin or blood thinners should continue to be taken as recommended by the ophthalmologist. The eye should not be rubbed, as this can increase the risk of re-bleeding immediately after onset, and is similar to a nosebleed being prone to re-bleeding in the early stages. However, in most cases, subconjunctival hemorrhage takes seven to 10 days to resolve on its own, and as the blood gradually disappears over time, the affected area may change color like a bruise.

References:
ncbi.nlm.nih.gov/books/NBK507802/
medscape.com/answers/1190165-159510/what-is-hyphema

Writer: Ozlem Guvenc Agaoglu


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