Blood in the anterior chamber (the front) of the eye is known as hyphema. It is associated with blunt trauma to the eye, and while pooling of blood may be clearly visible, the condition is sometimes only observable through using magnification.
You may be able to identify a pool of blood at the base of the iris, but the clearest indicator is diminished vision. Any amount of blood mixed with the clear fluid (aqueous humour) in the iris will cause a degree of vision loss, and if the amount of blood is great then the experience can be comparable to blindness, with only perception of light and movement remaining intact. In certain cases the intraocular pressure within the eye might be increased, which can be checked as part of a simple eye exam.
Hyphema is generally the consequence of a projectile or a physical force such as a punch that directly strikes the front of eye. This is usually prevented by the protecting structure of the orbital rim, making hyphema often the result of being hit by chance at a particularly bad angle or position. In sport anything from a variety of balls to a hockey puck can cause the damage. The condition can also be provoked during or after eye surgery.
A medical professional will need to ascertain the cause of the injury. Detail about the event leading to the hyphema is therefore important. You will be given eye tests to measure the extent of the damage caused by the hyphema, thus helping the doctor to determine the correct course of treatment.
Grades of Injury
Your doctor will often use a grading system to assess the severity of the condition. These grades broadly correspond to the amount of blood and visual loss present in the eye. Grade 1 is when blood fills less than a third of the eye's anterior chamber; Grade 2 fills more than this but less than one half; Grade 3 can be anything above half that does not fill the entire chamber; and Grade 4 is complete coverage. A majority of hyphemas are Grade 1, with only a small minority reaching Grade 4.
Initially an in-depth medical history will be taken and a full physical exam conducted. You may be referred to an ophthalmologist, whereupon you will be advised on relevant treatment. This regularly includes careful rest at an elevated angle in order to maximise the chances of the blood being reabsorbed, as well as a course of appropriate eye drops. Occasionally a procedure is necessary to reduce risks of glaucoma and other conditions. In some cases the patient becomes at risk of chronic visual impairment and surgery is necessary. All treatment options depend on the severity and progress of the injury, which will be carefully monitored by your doctor.
Wearing eye guards while playing sports, particularly high-speed ball games, significantly decreases your chances of being struck and developing hyphema.
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