A hyphema is a collection of blood in the anterior chamber and is usually the result of trauma. The eyeball is compressed, and the anterior ciliary body tears, leading to bleeding.
The grades are estimated by volume of the anterior chamber
I: <1/3
II: 1/3 to 1/2
III: >1/2
IV: complete
The higher the grade, the greater the risk for re-bleeding. Ophtho may consider hospitalizing a grade II-III, elevated intraocular pressure, patients with sickle cell disease, or in social situations where close outpatient follow up isn’t assured. A grade IV hyphema means that the entire anterior chamber is full of blood, and is also known as an ‘eight-ball hyphema.’
Generally hyphemas are managed conservatively with close follow-up. The success of treatment, as judged by the recovery of visual acuity, is good in approximately 75% of patients.
- 80% of those with grade I regain visual acuity of 20/40 or better
- 60% of those with a grade III regain visual acuity of 20/40 or better
- 35% of those with a grade 4 hyphema have good visual results
Treat with rest, unilateral patch/shield, acetaminophen (but not ibuprofen), and elevating the head of the bed. Other therapies are controversial, and are at the discretion of the Ophthalmologist.
