Hyphema (Blood in the Anterior Chamber)

Hyphema is the presence of blood within the anterior chamber. The blood originates from uveal or retinal vessels. Its color can help indicate duration: fresh blood is bright red and darkens over time. Blood generally accumulates in the ventral anterior chamber.

Primary ocular and systemic diseases can cause hyphema. Causes listed in the source include congenital abnormalities such as Collie Eye Anomaly, merle ocular dysgenesis, retinal dysplasia, and persistent hyaloid vasculature; uveitis; retinal detachment; trauma; coagulopathies; vasculopathies; hypertension; neoplasia; autoimmune disease; and some systemic infectious diseases. Complications may include cataract, phthisis bulbi, secondary glaucoma, and posterior synechiae.

Treatment

Diagnosis is made by ophthalmic examination. The examination must be detailed because hyphema may obscure the primary ocular disease and can also cause secondary complications such as glaucoma or retinal detachment. When hyphema is extensive and the anterior segment cannot be visualized, ultrasonography is required. If no ocular cause is identified, the history should be reviewed carefully for recent trauma and systemic causes of bleeding investigated. Recommended tests include complete blood count, serum biochemistry, coagulation testing, blood-pressure measurement, and infectious-disease testing. Radiography can identify a metallic intraocular foreign body or orbital fracture.

Treatment is directed at the underlying cause. Mild hyphema may gradually resorb without significant consequences. When indicated, topical corticosteroid anti-inflammatory treatment and mydriatics are used, and tissue plasminogen activator (tPA) may be injected intracamerally. Prognosis depends on the cause and on complications; tumors and severe trauma carry a particularly poor prognosis and may result in loss of vision or the eye.

Hyphema in a cat secondary to systemic hypertension.

Hyphema in a dog after blunt trauma and scleral rupture.

Adapted from the Atlas of Ocular Diseases in Dogs and Cats by Dr. Siniša D. Grozdanić and colleagues. © Animal Eye Consultants of Iowa. The text and clinical images on this page are original content from the authors' own clinical practice and research, and may not be reproduced, distributed, or repurposed without permission.

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