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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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Rosen, Peter, et al., editors. "Hyphema." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307355/all/Hyphema.
Hyphema. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307355/all/Hyphema. Accessed April 26, 2019.
Hyphema. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307355/all/Hyphema
Hyphema [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307355/all/Hyphema.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hyphema ID - 307355 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307355/all/Hyphema PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -