Hyphaema is the collection of erythrocytes in the anterior chamber of the eye. It is a result of haemorrhage from the ciliary vasculature.
Causes
Blunt trauma is the primary cause, though penetrating trauma may also produce hyphaema.
Spontaneous hypaema
- Leukemia,
- Haemophilia,
- von Willebrand disease,
- Sickle cell anaemia,
- Anticoagulation.
Neovascularisation (typically associated with diabetes mellitus), increases the risk of hyphaema due to all causes.
Grades
- Grade 0 - microhyphaema (scattered cells without layering),
- Grade I - less than 1/3 of the chamber involved,
- Grade II - between 1/3 and 1/2 of the chamber involved,
- Grade III - more than 1/2 but less than 100% of the chamber involved,
- Grade IV - total filling of the anterior chamber.
Management
The author is sure that ophthalmology would like to know about your patient’s hyphaema, and they are probably the only ones that should prescribe cycloplegic medicines. The principle of cycloplegia is to paralyse the iris to limit any further vascular injury and subsequent rebleeding. Increased intraocular pressure must be excluded as dilating the iris obstructs the anterior chamber’s outflow tract.
The opthalmologists may also like to do surgery in the case of penetrating injury, globe rupture, or some other kind of terrible thing.
If the patient is coaguloapthic you can, and should, investigate and fix this.
Further reading:
- Oldham GW, et al. Hyphema. EyeWiki; 2025 Sep 5. Link.