Surgery may be necessary for non-resolving hyphemas, or hyphemas that are associated with high pressure that does not respond to medication. There is little evidence that most of the commonly used treatments for hyphema (antifibrinolytic agents, corticosteroids, cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest) are effective at improving visual acuity after two weeks. Small hyphemas can usually be treated on an outpatient basis.
The main goals of treatment are to decrease the risk of re-bleeding within the eye, corneal blood staining, and atrophy of the optic nerve. Source of bleeding in hyphema with blunt trauma to eye is circulus iridis major artery. Conditions or medications that cause thinning of the blood, such as aspirin, warfarin, or drinking alcohol may also cause hyphema. Additional causes of spontaneous hyphema include: rubeosis iridis, myotonic dystrophy, leukemia, hemophilia, and von Willebrand disease. Spontaneous hyphemas are usually caused by the abnormal growth of blood vessels ( neovascularization), tumors of the eye ( retinoblastoma or iris melanoma), uveitis, or vascular anomalies ( juvenile xanthogranuloma). Hyphemas may also occur spontaneously, without any inciting trauma. The most common causes of hyphema are intraocular surgery, blunt trauma, and lacerating trauma. Hyphemas are frequently caused by injury, and may partially or completely block vision. The anterior chamber is the light gray area at the top of this illustration. The eye is divided into a small front (anterior) segment, in front of the lens, and a large rear (posterior) segment, behind the lens. Young children with traumatic hyphema are at an increased risk of developing amblyopia, an irreversible condition. Rebleeding occurs in 4–35% of hyphema cases and is a risk factor for glaucoma.
Secondary hemorrhage, or rebleeding of the hyphema, is thought to worsen outcomes in terms of visual function and lead to complications such as glaucoma, corneal staining, optic atrophy, or vision loss. Traumatic hyphema may lead to increased intraocular pressure (IOP), peripheral anterior synechiae, atrophy of the optic nerve, staining of the cornea with blood, re-bleeding, and impaired accommodation. While the vast majority of hyphemas resolve on their own without issue, sometimes complications occur.
A full hyphema (total hyphema), when blood fills up the chamber completely, is the most severe. A layered hyphema when fresh blood is seen lower in the anterior chamber is moderately severe. A microhyphema, where red blood cells are hanging in the anterior chamber of the eye, is less severe. In many people, the vision will improve, however some people may have other injuries related to trauma to the eye or complications related to the hyphema. The person's vision may improve over time as the blood moves by gravity lower in the anterior chamber of the eye, between the iris and the cornea. A person with a full hyphema may not be able to see at all (complete loss of vision). People with microhyphema may have slightly blurred or normal vision. A decrease in vision or a loss of vision is often the first sign of a hyphema.