A hyphema is the collection of blood in the anterior chamber of the eye, the space between the cornea and the iris. This condition is often caused by trauma that tears blood vessels in the front of the eye. The blood can interfere with vision, cause pain, and increase pressure inside the eye. Due to the risk of serious complications and permanent vision problems, a hyphema is a medical emergency that requires immediate evaluation by an ophthalmologist.
The Correct Patient Position
Proper positioning is an important part of managing a hyphema, using gravity to facilitate healing. Patients are instructed to maintain a head-elevated position of 30 to 45 degrees at all times, including during sleep. This angle encourages the suspended red blood cells to settle in the lower portion of the anterior chamber. This process is similar to allowing sediment in a jar of water to settle at the bottom.
This gravitational settling is important for two reasons. First, it helps prevent red blood cells from obstructing the eye’s natural drainage system, the trabecular meshwork. If this meshwork becomes clogged, the eye’s internal fluid cannot drain properly, leading to a spike in intraocular pressure.
Keeping the blood pooled low also protects the cornea. If red blood cells remain in contact with the cornea’s inner layer for a prolonged period, they can release iron and stain the tissue. This complication, called corneal blood staining, can cause long-term vision clouding. Head elevation keeps the bulk of red blood cells away from the central visual axis.
Associated Activity Restrictions
Managing a hyphema also requires a significant reduction in physical activity. Bed rest or severely limited activity is prescribed to prevent jarring the head, which could dislodge the fragile clot over the injured blood vessel. Such a disruption can lead to a re-bleed, which is often more significant than the initial injury.
Activities that increase blood pressure, such as bending over or heavy lifting, are also forbidden. An elevation in blood pressure can be transmitted to the vessels within the eye, increasing the risk of a re-bleed. This helps keep cardiovascular dynamics stable, allowing the injured vessel to heal without additional stress.
Even minor activities are curtailed to promote recovery. Reading and screen time are limited because they require constant, rapid eye movements. These movements can agitate the anterior chamber’s contents and disturb the settling blood and the clot. Minimizing exertion helps create a stable internal environment for the eye to heal.
Why Positioning and Rest Are Critical
Adherence to head elevation and activity restrictions is necessary to avoid serious complications. The most immediate risk of non-compliance is a re-bleed, which can occur within the first few days after the injury. A re-bleed introduces a larger volume of blood into the anterior chamber, worsening the prognosis and increasing the likelihood of other complications.
A severe consequence is acute glaucoma, a rapid and painful increase in intraocular pressure. This high pressure places stress on the optic nerve. If not controlled quickly, it can cause irreversible damage to the optic nerve fibers, leading to permanent vision loss.
Another risk is corneal blood staining, which can make the cornea cloudy and opaque. This is more likely with a large hyphema or if blood remains in the anterior chamber for an extended period. A stained cornea may not clear on its own and could require a corneal transplant to restore sight.