Long-lasting hyphema can cause Hyphema of the eye: causes, symptoms, treatment

As a rule, three main reasons lead to the condition of hyphema:

Injuries to the eyeball. Such injuries occur with damage to the membranes of the eye (penetrating) and without damage - non-penetrating, called blunt.

Penetrating injuries are characterized by rupture of the membranes of the eye and damage to the blood vessels, which causes blood to flow into the anterior chamber area.

With non-penetrating injuries, bleeding occurs due to a sharp change in intraocular pressure, which causes rupture of blood vessels or the inner membranes of the eye (including the iris - the anterior wall of the choroid, which performs a protective function; which is part of the choroid and consists of several muscles, changing the shape of the lens; choroid - providing nutrition to the outer layers). Eye injuries are the most common cause of hyphema.

Operations on the eyes. When performing abdominal or laser eye surgeries, bleeding may occur as one of the complications of surgical intervention. In this case, the cause is damage to the vessels of the iris and ciliary body. As a rule, surgeons cope with such bleeding during the operation. However, hephemas can also be observed after surgery for several months. This is caused by bleeding of the affected vessel or the growth of newly formed vessels, which occurs in the area of the surgical incision.

Eye diseases, which are accompanied by the growth of newly formed vessels in the iris. Such diseases include: uncompensated diabetes mellitus, intraocular tumors, central vein thrombosis and some others. At the same time, growing newly formed vessels have fragile walls that rupture at the slightest fluctuations in blood pressure, causing bleeding.

General diseases of the body. Diseases that provoke intraocular bleeding usually include: hemophilia, anemia, blood cancer, as well as alcoholism, which leads to a decrease in blood clotting, as a result of which bleeding occurs without obvious reasons.

Symptoms

Diagnosis of hyphema

Establishing a hyphema begins with collecting anamnesis, including information about recent injuries and eye surgeries, because these are the most likely causes.

If nothing like this happened, it is necessary to exclude other causes of hyphema: systemic diseases, taking blood thinners. In this case, a blood clotting test is mandatory for all patients.

Complications of hyphema

Blood spilled into the anterior chamber of the eye can cause a number of complications. Such complications are especially often observed when the space of the anterior chamber is significantly filled with blood.

These include:

Blood staining, which leads to a decrease in visual acuity due to the fact that it takes a very long time to resolve, even if the bleeding itself has already stopped;

An increase in intraocular pressure, called , is often observed with varying amounts of blood shed.

Treatment of hyphema

There are several treatment options for hyphema, and the choice of one of them depends on the reasons that caused this condition, the amount of bleeding, the presence of complications, and the duration of the hemorrhage.

Hemostatic, vascular-strengthening, and absorbable agents are prescribed. If systemic bleeding disorders are detected, appropriate treatment is prescribed. To speed up the resorption of hemorrhage, blood thinning drugs (disaggregants, anticoagulants) are discontinued if they were used.

Sometimes there are indications for surgical intervention - removal of blood or blood clots from the anterior chamber. Surgery is necessary if the cornea begins to become stained with blood; if the blood has already coagulated and formed a clot; if the anterior chamber is completely filled with blood and it does not resolve within 5-10 days after receiving appropriate treatment; if there is an increase in intraocular pressure, and the use of local or general drugs to reduce intraocular pressure is ineffective.

Having discovered suspicious symptoms, it is necessary to show the patient to a doctor as early as possible in order to make a correct diagnosis, prescribe adequate treatment and avoid the development of complications, which will be much more expensive to treat.

Hyphema is the presence of blood in the anterior chamber. The amount of blood can be microscopic (microgyphema), when red blood cells in the aqueous humor are visible only with biomicroscopy, or the blood is located in a layer in the anterior chamber.

With total hyphema, blood fills the entire anterior chamber. Total hyphema with clotted blood turns black and is called grade eight. Traumatic hyphema is associated with blunt or penetrating injury to the eye. For the most part, hyphemas gradually resolve on their own without any consequences, but repeated bleeding, increased intraocular pressure, and staining of the cornea with blood may also occur.

Epidemiology of traumatic hyphema

Traumatic hyphema occurs with blunt or penetrating trauma. Traumatic hyphemas are typical for young active men, the ratio of the frequency of its occurrence in men and women is approximately three to one. The risk of complications, such as recurrent bleeding, uncontrolled rise in intraocular pressure, or blood staining of the cornea, increases as the size of the hyphema increases. The exception is patients with sickle cell hemoglobinopathies. Such patients are at increased risk of developing complications, regardless of the size of the hyphema.

Up to 35% of patients suffer from recurrent bleeding. In most cases, repeated bleeding develops within 2-5 days after injury, usually more massive than the previous hyphema, with a greater tendency to develop complications.

Pathophysiology of traumatic hyphema

Compressive forces during blunt trauma rupture the iris and vessels of the ciliary body. Ruptures of the ciliary body lead to damage to the large arterial circle of the iris. Penetrating injuries cause direct damage to blood vessels. Clots of coagulated blood clog damaged vessels. Re-bleeding develops with retraction and lysis of these clots. Intraocular pressure increases acutely when the trabecular meshwork is blocked by red blood cells, inflammatory cells and other organic substances. In addition, intraocular pressure increases with pupillary block, a blood clot in the anterior chamber, or mechanical blockage of the trabecular meshwork. This form of pupillary block often occurs with eight-grade hyphemas - total collapsed hyphemas that impede the circulation of intraocular fluid. Impaired circulation of aqueous humor leads to a decrease in oxygen concentration in the anterior chamber and blackening of the clot.

In patients with sickle cell disease and other conditions, when sickle cells form, red blood cells become rigid and easily become trapped in the trabecular meshwork, increasing intraocular pressure even when the hyphema is small. With microvascular disorders, patients may experience vascular occlusion and damage to the optic nerve head at low intraocular pressure values.

Symptoms of traumatic hyphema

Patients have a history of trauma. Careful questioning about the timing and mechanism of injury is important to assess the likelihood of additional injuries and the need for in-depth evaluation and treatment. The disease in patients may be asymptomatic; visual acuity may decrease, photophobia and pain may appear. Increased intraocular pressure is sometimes accompanied by nausea and vomiting. There may be signs of orbital trauma or damage to other eye tissues.

Diagnosis of traumatic hyphema

Biomicroscopy

When examined using a slit lamp, red blood cells and sometimes hyphema are found circulating in the anterior chamber. There may be symptoms of trauma in other structures of the eye, such as cataracts, phacodenesis, subconjunctival hemorrhage, foreign bodies, wounds, iris sphincter tears, or tears at the root of the iris (iridodialysis).

Gonioscopy

Gonioscopy should be performed after the risk of rebleeding has disappeared. As time passes, 3 to 4 weeks after injury, the angle may appear intact or, more often, recession of the angle may be detected. Possible formation of cyclodialysis.

Posterior pole

Signs of blunt or penetrating trauma may be seen at the posterior pole. Retinal concussion, choroidal tears, retinal detachments, intraocular foreign bodies, or vitreous hemorrhage may occur. Scleral impression testing should be postponed until the risk of rebleeding has passed.

Special tests

Ultrasound B-scan should be performed in every patient if it is not possible to study the posterior pole. If orbital fractures or an intraocular foreign body are detected during a clinical examination, the patient is referred to a computed tomography scan of the orbit.

Treatment of traumatic hyphema

The affected eye is covered with a bandage, and the patient is placed on the bed in a position with his head elevated. It is necessary to avoid taking acetylsalicylic acid, non-steroidal anti-inflammatory drugs; local cycloplegic agents and glucocorticoids are used. To prevent rebleeding, the patient takes (orally) aminocaproic acid and antifibrinolytics. Aminocaproic acid can cause postural hypotension, nausea and vomiting, so its use should be avoided during pregnancy and in patients with cardiac, hepatological or renal diseases. When intraocular pressure increases, beta-blockers, α-adrenergic agonists or carbonic anhydrase inhibitors are prescribed locally. Miotics can cause inflammation and should not be prescribed. In addition, carbonic anhydrase inhibitors are prescribed orally or intravenously, with the exception of patients with sickle cell hemoglobinopathies, since they increase the pH of the intraocular fluid, increasing the formation of sickle hemoglobin. Such patients should be very carefully prescribed hyperosmotic agents, since an increase in blood viscosity leads to an increase in the concentration of the pathological form of hemoglobin.

Surgical intervention is indicated for patients with extensive non-absorbable hyphemas and early corneal imbibition with blood, as well as in cases with uncontrolled intraocular pressure. The timing of surgery to control intraocular pressure is individual and depends on the patient. Surgery is necessary for patients with a normal optic disc and an intraocular pressure of 50 mm Hg. for 5 days or more than 35 mm Hg. within 7 days. Patients with an altered optic disc, corneal endothelial pathology, sickle cell hemoglobinopathy or its signs require earlier surgery. In addition, surgery is indicated for patients with sickle cell anemia when intraocular pressure is more than 24 mmHg. and lasting more than 24 hours.

Surgical procedures to remove hyphema include irrigation of the anterior chamber, squeezing the blood clot through an incision in the limbal region, or removing it with anterior vitrectomy instruments. To prevent re-bleeding, the blood clot is removed from 4 to 7 days after the injury. In most cases, gentle filtering surgery is usually performed to control intraocular pressure.

We receive about sixty percent of information through the organs of vision. But there are diseases that can deprive a person of this ability. One of them is hyphema. What kind of disorder is this, how to recognize it and can it be cured?

What is it?

Hyphema of the eye is a pathological process in which hemorrhage occurs in the anterior chamber of the eyeball. The severity of the pathological process can vary, ranging from a thin strip of blood, which can only be seen under a microscope, to a significant amount of blood that fills the entire space of the anterior chamber. With hyphema, blood always settles in the lower part of the eyeball. This is explained by the fact that blood is much heavier than intraocular fluid.

The disease negatively affects the quality of vision. With severe hemorrhage, visual acuity drops to the level of light perception. Hyphema can be the result of severe trauma or medical manipulations performed on the eyeball.

Hemorrhage into the anterior chamber of the eye is a rather rare phenomenon, which in most cases is diagnosed in young people under twenty years of age, as well as in the elderly. Hyphema does not go away without a trace; its formation negatively affects the conduction of light to the retina, local homeostasis, as well as intraocular pressure.

What could be the reason?

Hyphema of the eye can form due to the following reasons:

injury. We are talking about both a penetrating wound and a blunt wound;
ophthalmological operations. The greatest danger is posed by hemorrhages that developed during the first few days after surgery;
physical activity. Hemorrhage can occur in pregnant women during pushing, as well as with strong screaming;
tumor process. The neoplasm compresses and damages blood vessels;
eye diseases. Diabetes mellitus at the stage of decompensation, thrombosis of the central retinal vein, neoplasms - all these pathologies can cause the development of new blood vessels with thin walls. But when there is a difference in arterial or intraocular pressure, these vessels burst, which leads to hemorrhage. Myopia and retinal angiopathy can also cause hyphema;
diseases of the coagulation system: hemophilia, leukemia, anemia;
circulatory diseases: atherosclerosis, microaneurysms, stenosis of vessel walls, arterial hypertension.

Trauma is a common cause of hyphema.

Separately, I would like to say about eye contusion. According to statistics, it is blunt trauma to the eye that causes hyphema. Experts distinguish three degrees of severity of concussion:

Easy. No visible damage to the eye tissue was detected. Functional disorders are reversible.
Average. Slight damage to eye structures is typical. Vision drops to light perception.
Heavy. Disturbances in the structures of the eye are irreversible. Cosmetic death of the eyeball and complete loss of vision are observed.

Degrees and types

Depending on the amount of blood spilled, experts distinguish three degrees of ocular hyphema:

The blood level does not exceed two millimeters. There are blood smears on the iris.
The blood level reaches two to five millimeters.
Total hyphema.

In the absence of visible changes, doctors talk about microhyphema, which can be detected under a microscope.

Total hematoma is fraught with complete blindness

Blood may appear in the anterior chamber, vitreous, retina, and orbital cavity. With hemorrhage into the cavity of the anterior chamber of the eye, a uniform red formation with smooth contours is observed. If a person is in a horizontal position, blood can spread over all surfaces of the anterior chamber. When the body is in a vertical position, blood usually settles to the bottom of the anterior chamber of the eye. Blood clots usually resolve within a few days.

The appearance of blood in the vitreous area is called hemophthalmos. Hemorrhage is a brown formation behind the lens. Hemophthalmos manifests itself in the form of flashes of light before the eyes and dark moving spots. Total hemorrhage leads to complete loss of vision. Hemophthalmos threatens retinal detachment and atrophy of the eyeball.

Hemorrhage in the retina of the eye practically does not manifest itself in any way. And this is regardless of the degree of involvement of retinal tissue in the pathological process. Patients complain of blurred vision of objects and the appearance of spots before their eyes. Extensive hemorrhages can lead to vision loss.

Hemorrhages in the orbit can be the result of trauma, vasculitis and blood diseases. Patients experience bulging of the eyes, decreased vision, forward displacement of the eyeball, limited motor function of the eye, hemorrhage under the skin of the eyelids and conjunctiva.

Symptoms

You can suspect a hyphema based on the following signs:

clouding and deterioration of visual acuity, the appearance of spots;
painful sensations;
increased sensitivity to light;
accumulation of blood in the eyeball.

Hyphema causes severe pain

Possible consequences

A hematoma on the eye is fraught with the following complications:

staining of the cornea with blood and, as a result, an increase in size;
deterioration of vision, up to blindness;
optic nerve atrophy;
fusion of the cornea and iris;
amblyopia, in which one eye does not participate in the visual process;
secondary glaucoma.

Diagnostic examination

Hyphema causes characteristic clinical symptoms, so diagnosis, as a rule, does not cause any difficulties. However, to determine the severity and presence of complications, a number of studies will have to be carried out:

collection of complaints;
examination of the eyeball;
examination of the retina with a dilated pupil;
biomicroscopic diagnostics;
measurement of intraocular pressure;
CT scan of the orbit and brain.

Diagnosis will determine the severity

Features of treatment

Treatment of hyphema directly depends on the volume of hemorrhage, general condition, as well as existing concomitant pathologies and complications. Only with minor injuries can one hope for spontaneous resorption of the hematoma.

The basic principles of treatment include the following:

compliance with bed rest, while the head should be higher than the feet;
drug therapy;
applying a sterile bandage to the affected eye;
restriction of physical activity;
local use of glucocorticosteroids.

Patients are hospitalized for at least five days. This is due to the fact that in more than thirty percent of cases, a relapse occurs on the second to fifth day.

To relieve pain and prevent relapse, glucocorticosteroids are prescribed in the form of eye drops - Prednisolone and Dexamethasone. To combat intraocular pressure, beta-blockers in the form of drops are prescribed - Trusopt, as well as Apraclonidine and Dorzolamide.

A sterile bandage is applied to the affected eye

Mydriatics - Atropine - will help eliminate pain and photophobia. If the cause of hyphema is injury, then specialists prescribe hemostatic drugs, for example, Aminocaproic acid. Actovegin and Emoxipin are used to strengthen blood vessels.

Indications for surgical intervention are:

significant visual impairment;
saturation of the cornea with blood;
total hematoma;
presence of a blood clot for more than seven days;
persistence of elevated intraocular pressure despite the use of medications.

The essence of the surgical intervention is to perform two punctures. One is designed for removing blood clots, and the second is for introducing saline.

Even after recovery, patients should undergo regular examinations by an ophthalmologist. The prognosis is favorable with timely diagnosis and proper treatment.

So, hyphema, that is, hemorrhage in the anterior chamber of the eye, is a dangerous disease that can lead to complete blindness. If the above symptoms occur, it is extremely important to contact a specialist immediately. You can preserve your vision if you follow all medical recommendations.

Hyphema is a pathological process that is accompanied by hemorrhage into the anterior chamber of the eyeball, filled with intraocular fluid. Blood accumulates between the iris and lens. This phenomenon can lead to the development of serious complications, so at the first symptoms it is important to visit a doctor and get diagnosed.

What is it

With hyphema, blood and its clots accumulate in the anterior chamber of the optic organ. This occurs as a result of injury, rupture of newly formed vessels, or against the background of existing hematological pathologies.

Hyphema caused by trauma is common in men. But all other reasons for the spread of pathology in ophthalmology are distributed in equal proportions. People over 40 have an increased tendency to develop the disease. And in infants, the pathology can be formed against the background of the “shaking” syndrome or congenital blood diseases.

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Video shows hyphema of the eye:

The disease is accompanied by a complicated course, and without adequate therapy its progression cannot be ruled out. Without treatment, it will result in complete loss of vision. More than 35% of cases relapse on days 2-5.

Reasons

Eye hyphema can occur against the background of existing diseases, after injury or surgery on the eyeball. Let's consider each case in more detail.

Injury to the eyeball

In case of injury, the membrane of the visual organ may be completely damaged or not damaged at all. If we consider the first option, then such an injury is called penetrating. Here is an injury without damage to the membrane of the eye - blunt trauma. Here's how the treatment works at home:

Penetrating damage is accompanied by rupture of the membranes of the organ of vision with blood vessels. From here the blood moves into the anterior chamber. With blunt trauma, bleeding occurs against the background of a sharp surge in pressure inside the eyeball. Because of this, blood vessels rupture. It might even happen

In the video, injury to the eyeball:

In addition, the internal membranes of the organ of vision may also be subject to rupture:

Iris– the anterior part of the vascular organ of vision, which protects the membranes from the negative influence of various factors.
Ciliary body- part of the vascular, which consists of several muscles. Due to them, all changes in the shape of the lens are controlled.
Choroid– the choroid, through which all the outer layers of the retina receive proper nutrition.

Eyeball surgery

When performing abdominal or laser manipulations on the eyeball, hyphema can form as a complication. The cause of the development of pathology is damage to the vessels of the iris and ciliary body, which is accompanied by bleeding. As practice shows, doctors manage to cope with this phenomenon during surgery. But even after this, for several months there is a danger of developing hyphema.

In the video there is an operation on the eyeball:

Eye diseases

Pathological changes affecting the organs of vision occur against the background of newly formed vessels of the iris. These diseases include:

severe thrombosis of the central retinal vein;
tumors located inside the eye.

Growing vessels are equipped with defective walls. As soon as a slight jump in arterial and intraocular pressure occurs, the walls rupture, which leads to bleeding.

To prevent the disease, you can try using

General diseases of the body

Hyphema can be the result of various pathologies of the body. The most common ones include:

anemia;
blood cancer

If you abuse strong drinks, this entails a violation of the blood clotting ability, which causes bleeding for no apparent reason.

There is also such a problem as a veil before the eyes, but here is how you can get rid of it in a short time, it is indicated

Treatment

Therapy for hyphema is prescribed only after a complete diagnosis, and the specialist determines the method of treatment taking into account the cause of the pathology and the degree of its damage. Medications for the treatment of hyphema include antiplatelet agents and anticoagulants. The action of these drugs is aimed at thinning the blood.

To eliminate hemorrhage, the following medications are included in the treatment regimen:

If visible symptoms occur after drug treatment and the pain intensifies, you should immediately consult a doctor to review treatment.

Sometimes there are indications for surgical intervention. The essence of the operation is to remove blood and its clots concentrated in the anterior chamber. The operation is prescribed for the following indications:

In children, the pathological process can disappear on its own after a few days. And when diagnosing even a mild stage of hyphema in older people, it can turn into a severe form. Even with timely treatment, surgery will still have to be performed.

To obtain the maximum result from the treatment provided, the patient must follow the following recommendations:

Maintain bed rest.
Do not overload the body with physical activity.
During your night's rest, you should sleep with your head raised.
You should not use anesthetics, as they have a detrimental effect on blood clotting.
Cover the affected eye with a sterile bandage for 2-3 weeks. This will prevent the development of infection and complications.

Hyphema is a disease that has not very pleasant symptoms. It must be treated immediately after the formation of the first pathological phenomena. The success of therapy also depends on the correctly prescribed method of treatment. And for this, the patient must undergo diagnostics to determine the exact cause of the pathological process.

Hyphema is the formation of a blood clot in the eyeball as a result of injury or medical procedures. This condition leads to increased intraocular pressure and disruption of light transmission to the retina. For diagnosis, laboratory and instrumental examination methods are used, based on the results of which the doctor will determine the most effective treatment tactics.

Hyphema of the eye can be eliminated using both conservative and radical methods. The issue of hospitalization is decided on an individual basis, but treatment is also possible on an outpatient basis, depending on the severity of the pathological process. It is not recommended to use any medications on your own, including eye drops (Lidaza or Emoxipin).

Mild hyphema does not pose a threat to health, but if treatment is not started in a timely manner, a significant decrease in the quality of vision is possible. There are no clear restrictions regarding age and gender, but according to statistics, hyphema is most often diagnosed in young people (18-20 years old) and in the elderly.

According to the international classification of diseases, hyphema belongs to the section “other diseases of the iris”. The ICD-10 code is H21.0.

Etiology

Hyphema of the organ of vision can be caused by the following etiological factors:

mechanical damage to the eyeball as a result of a blunt blow or medical manipulation;
blood diseases in which poor clotting is observed;
systemic diseases that affect the vascular walls.

In more than 70% of cases, hyphema is combined with.

Classification

According to the nature of the prevalence of the pathological process, its degrees are distinguished:

microhyphema - the presence of blood can only be diagnosed using an ophthalmological microscope;
limited - the blood level is no more than 2 mm, there are blood smears on the iris;
average hyphema of the eye - blood level from 2 to 5 mm;
total hyphema - more than 5 mm of blood in the anterior chamber of the eye.

The severity of the pathological process is determined by the doctor by carrying out the necessary diagnostic measures.

Symptoms

Hyphema is clearly visible (with the exception of microhyphema) externally. In general, the clinical picture of this pathology is characterized as follows:

decreased visual acuity;
flashing “flies” before the eyes;
increased sensitivity to light stimuli;
sensation of a foreign body in the affected organ of vision;
soreness of the eyeball;
a veil or fog before the eyes.

The intensity of the clinical picture will depend on the severity of the pathological process, as well as on whether the patient has other ophthalmological diseases.

Diagnostics

If you have the above-described clinical picture, you should immediately seek medical help from an ophthalmologist. In most cases, diagnosis is not difficult due to the specificity of the clinical picture, however, in order to determine the severity of the disease, as well as the likelihood of complications, the following laboratory and instrumental diagnostic measures are carried out:

measurement of intraocular pressure;
CT scan of the eye orbit and brain;
two-dimensional ultrasound examination of the organ of vision;
examination of the retina using a special microscope;
biomicroscopy;
examination of the fundus and adjacent soft tissues.

Standard laboratory tests do not have diagnostic value, and therefore are carried out only when particularly necessary.

Treatment

The issue of hospitalization is decided on an individual basis, but, as a rule, a patient with such a diagnosis is hospitalized. With a microscopic form of hyphema, therapeutic measures are carried out on an outpatient basis.

Hyphema of the eye treatment involves both conservative and radical.

Conservative therapeutic measures include:

bed rest with the head of the bed raised;
applying a bandage to the affected organ of vision;
local treatment with glucocorticosteroids;
taking medications.

Your doctor may prescribe the following medications:

analgesics;
hemostatic;
eye drops – Lidaza or Emoxipin;
M-anticholinergics.

As a rule, such therapeutic measures lead to complete recovery on the 2-5th day.

Indications for surgical intervention are the following factors:

complete filling of the anterior eye chamber with blood;
significant decrease in vision;
saturation of the cornea with blood.

Surgery is also prescribed in cases where drug treatment does not give the desired result.

In most cases, if treatment is started in a timely manner, significant complications can be avoided. Therefore, at the first symptoms, you need to consult a doctor, and not treat yourself even with specific drugs, such as Emoxipin or Lidaza.

Possible complications

If this violation is not corrected in a timely manner, the following complications may develop:

decreased visual acuity or complete loss.

Prevention

The only effective method of prevention for this disease is to prevent injuries to the eyeball. In the event that there are pathologies that lead to a blood clotting disorder, then in case of injury it is imperative to take appropriate medications and urgently seek medical help.

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