Hyphema is a topic covered in the 5-Minute Emergency Consult.

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  • Blood in anterior chamber (AC) of the eye (between iris and cornea).
  • Hyphema: Grossly visible layering of blood.
  • Microhyphema: Suspended RBCs visible by slit-lamp only.
  • Genetics:
    • Genetic predisposition is related to hereditary blood dyscrasias (see below).


  • Blunt trauma: Most common (70–80%).
  • Anteroposterior compression of the globe with simultaneous equatorial globe expansion causing rupture of iris stromal/ciliary body vessels
  • Penetrating trauma: Direct injury to stromal vessels or sudden ocular decompression.
  • Spontaneous: Less common, lower incidence of complications:
    • Tumors:
      • Melanoma
      • Retinoblastoma
      • Xanthogranuloma
      • Metastatic tumors
    • Blood dyscrasias:
      • Hemophilia
      • Leukemia
      • Thrombocytopenia
      • Von Willebrand disease
    • Blood thinners: Aspirin, Coumadin, heparin
    • Neovascularization of iris: In proliferative diabetic retinopathy, retinal vein occlusion, carotid stenosis.
    • Postsurgical: Cataract extraction, trabeculectomy, pars plana vitrectomy.

In children with no history of trauma, suspect child abuse.

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