L/O/G/O

PATHOPHYSIOLOGY
AND COMPLICATION
OF HYPHEMA
Rince Liyanti

Infection and Immunology Subdivision

Department of Ophthalmology
Andalas University - Dr M Djamil Hospital

Introduction
HYPHEMA
Definition: Blood in the anterior chamber of eye,
which forming a coat which can be seen by naked eye
Microhyphema is the red blood cells in the aqueous
humor of the anterior chamber without grossly
visible blood
Most frequently caused by ocular trauma, after
intraocular surgery, and also can occur spontaneously

Introduction
The annual incidence is in Male, between
ages 10-20 years.
A tear at the anterior aspect of the ciliary body is the
most common site of bleeding and occurs in about 71% of
cases

In this review, well discuss about pathophysiology and

complications of hyphema

Anatomy
A
N
T
E
R
I
O
R

C
H
A
M
B
E
R

The anterior chamber is bordered

anteriorly by the cornea and
posteriorly by the iris diaphragm
and the pupil
The anterior chamber is filled
with aqueous humor.
Aqueous Humor passes through
the pupil to the anterior chamber,
then flows to trabecular
meshwork, the Schlemm canal,
sclera and episclera vein.

Anatomy

I
R
I
S

The most anterior extension of

the uveal tract
Blood vessels form the bulk of the
iris stroma
Anastomoses occur between the
arterial and venous arcades to
form the minor vascular circle of
the iris
The major arterial circle is
located at the apex of the ciliary
body, not the iris

Anatomy
S
I
L
I
A
R
Y
B
O
D
Y

The ciliary consists of 2 parts:

pars plana and pars plicata
The capillary plexus of ciliary process
arterioles as they pass anteriorly and
posteriorly from the major arterial circle
The main arterial supply to the ciliary
body comes from the anterior and the
long posterior ciliary arteries.
The major veins drain posteriorly
through the vortex system

Pathophysiology
Mechanism of Traumatic Hyphema
Compressive
force to the
globe or
trauma

Injury to the
iris, ciliary body,
trabecular
meshwork, and
their associated
vasculature

Accumulation
of blood cells
within the
anterior
chamber

Pathophysiology

Pathophysiology
Surgery (Intraoperatif, early, late) :
Trauma directly in the siliar body and iris, dilatation
of the vessel post surgery
Spontan Hyphema :
Iris vessel fragility, so the minor
trauma might precipitate hyphema, or in patients
using drugs that alter platelet or thrombin
function

Classification
Hyphema is classified by the amount of blood in
the anterior chamber

Complication
Increased Intraocular Pressure
IOP is increased because of :
Occlusion of trabecular meshwork by clot, inflammatory
cell or RBC debris
Pupillary block due to blood clot
Peripheral anterior synechiae
Other late causes : damaged trabecular meshwork with
angle recession, fibrosis of trabecular meshwork,
siderosis of trabecular endothelium and ghost cell
glaucoma

Complication
Secondary Hemorrhage/ Rebleeding
Usually occurs on the third day or the fourth day, but it
may occur from the second day to the seventh day after
trauma
Size of the hyphema increases
A layer of fresh blood is looked over the clot
Darker clot in the anterior chamber
Dispersed of the erythrocytes appear over the clot

Complication
Posterior and Peripheral Anterior Synechiae
Persistence of the hyphema for more than 9 days
formation of peripheral anterior
synechiae (PAS).
Synechia formation is the result of inflammation
or clot organization

Complication
Corneal Bloodstaining
Corneal bloodstaining tends to occur in the
larger hyphemas, rebleeding, prolonged clot
duration, sustained increased intraocular
pressure, and corneal
endothelial cell dysfunction
The earliest sign of corneal
bloodstaining is a straw
yellow discoloration of the
deep stroma

Complication
Optic Atrophy
In the setting of traumatic hyphema, optic
atrophy tends to occur as a result of
elevated intraocular pressure or due to optic
nerve contusion
The risk optic atrophy related to elevated
intraocular pressure if remain at > 50 mm Hg
for 5 days or > 35 mm Hg for 7 days

Conclusion
1

2
80%

Hyphema most frequently caused by ocular trauma,

after intraocular surgery, or spontaneously
Bleeding
generally occurs from : major arterial circle
9%
and branches of the ciliary body, choroidal arteries,
ciliary body vein, iris vessels
55%

Mechanism of Hyphema is the compressive force to the

globe or30%
trauma will make the injury to the vessel, and the
accumulation of blood cells within the anterior chamber

Complication : Increased Intraocular Pressure,

secondary hemorraghe, posterior synechiae,
peripheral anterior synechiae, corneal bloodstainning

L/O/G/O

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