Can Trauma Cause a Hyphema (Broken Blood Vessel) in the Eyes?

by Oct 12, 2025

Can Trauma Cause a Hyphema Broken Blood Vessel in the Eyes?

A hyphema is bleeding in the anterior chamber of the eye, which is the space between the cornea and the iris. It appears as a visible pool or layer of blood inside the eye and should be considered an ocular emergency. Trauma is the most common cause of hyphema.

 

What Is a Hyphema

A hyphema occurs when blood vessels in the iris or ciliary body break and leak blood into the anterior chamber. The amount of blood can range from microscopic red blood cells that are only visible under a microscope to a large clot that fills most of the chamber. Even small hyphemas can be serious because they can raise eye pressure and damage the optic nerve if not treated promptly.

 

How Trauma Causes Hyphema

Blunt trauma to the eye is the leading cause. A direct impact from a ball, elbow, fist, or other object can compress the eye and stretch internal tissues, tearing delicate blood vessels in the iris and adjacent structures. Penetrating injuries can also cause bleeding, but these involve an open wound and require immediate surgical attention.

After the initial injury, blood may rebleed within the first week as clots dissolve and fragile vessels reopen. This secondary bleed can be more serious than the first and significantly increases the risk of complications, which is why close monitoring is crucial.

 

Symptoms and Warning Signs

Patients typically notice sudden vision changes in the injured eye. Common symptoms include blurred or dim vision, a visible reddish tinge or layering of blood, eye pain, light sensitivity, and a feeling of pressure. Some patients see a horizontal blood level that shifts with head position. If you suspect a hyphema after an eye injury, seek urgent evaluation the same day.

 

Risk Factors That Worsen Outcomes

Certain factors increase the likelihood of complications. Larger hyphemas, uncontrolled high eye pressure, sickle cell disease or trait, use of blood thinners, and delayed treatment can all worsen prognosis. Children and older adults may have additional risks due to difficulty reporting symptoms or preexisting eye conditions.

 

How a Hyphema Is Diagnosed

An eye care professional will perform a comprehensive examination. This includes measuring visual acuity, checking intraocular pressure, and inspecting the anterior chamber with a slit lamp to grade the amount of blood. The pupil and iris are evaluated for damage, and the retina is examined when possible. If the view is limited due to blood or corneal haze, ultrasound imaging may be used to assess the back of the eye for retinal detachment or other internal injury. Patients at risk for sickling may undergo blood testing because sickled red cells can obstruct the eye’s drainage angle and raise pressure.

 

Initial Treatment and Home Care

Most traumatic hyphemas are managed with conservative therapy. Bed rest with the head elevated helps the blood settle and promotes clearance. A rigid eye shield is used to protect the eye from further trauma. Strenuous activity is avoided, including bending and lifting, to reduce the risk of rebleeding. Many clinicians limit aspirin and nonsteroidal anti-inflammatory drugs because they can increase bleeding tendency. Pain is treated with alternatives such as acetaminophen unless otherwise directed by a physician. 

Topical medications are commonly prescribed. Cycloplegic drops rest the iris and reduce pain and the risk of further vessel tearing. Topical steroids decrease inflammation that can clog the eye’s drainage angle. Intraocular pressure is monitored closely, and pressure-lowering drops are added if needed.

 

Monitoring and Follow-Up

Frequent follow-up is essential during the first week when rebleeding risk peaks. Eye pressure, corneal clarity, and the amount of blood are reassessed at each visit. Patients with sickle cell disease or trait require especially careful pressure management, as even moderate pressure elevations can harm the optic nerve. If the cornea begins to stain with blood pigment or pressure remains high despite medication, more aggressive treatment is considered.

 

When Surgery Is Needed

Surgical intervention may be necessary for large or nonresolving hyphemas, uncontrolled high eye pressure, or corneal blood staining. Procedures aim to remove clotted blood from the anterior chamber and restore normal fluid drainage. The decision is individualized based on the size of the hyphema, duration, pressure levels, and overall ocular findings. Prompt surgery can prevent permanent vision loss from optic nerve damage or corneal staining.

 

Possible Complications

Untreated or severe hyphema can lead to several complications. Elevated intraocular pressure can damage the optic nerve and cause glaucoma. Corneal blood staining can cloud the cornea and reduce vision, sometimes permanently. Peripheral anterior synechiae may form when the iris adheres to the cornea at the drainage angle, causing chronic pressure problems. Traumatic iritis, lens damage, and retinal injuries may accompany hyphema and also affect vision outcomes.

 

Prevention and Protective Measures

Many sports-related hyphemas are preventable. Protective eyewear that meets sport-specific safety standards should be worn during activities with a risk of eye impact. Workplaces with flying debris or projectile risks require approved eye shields. Individuals with a history of eye trauma, prior hyphema, or eye surgery should be especially cautious. 

If an eye injury occurs, avoid rubbing the eye, apply a rigid shield rather than a compress, and seek prompt medical care. Early evaluation improves outcomes and reduces the risk of rebleeding and pressure-related damage.

 

 

Dr. Nathan Abraham and the staff of the Abraham Eye Center specialize in cataract surgery, LASIK, PRK, and various corneal surgeries.  Call our ophthalmologist in Valencia, CA today at 661-977-7377 or schedule an appointment online if you are interested in learning more about how trauma can cause a hyphema (ie: broken blood vessel) inside the eye.  Our eye doctor provides only the highest quality eye care and surgical services amongst eye doctors in the Valencia California area.

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