Hyphema is a bleeding into the anterior chamber of the eye, as a result of blunt trauma, and is recognized by a pool of blood partially filling the iris (coloured part) of the eye. This is a very serious injury. Any direct trauma should be managed with extreme caution because of the chance of permanent damage to the eye, leading to blindness.

Signs and Symptoms

• Immediate pain and a high degree of anxiety.
• Athlete usually covers the eye with his/her hand.
• Athlete may complain of seeing spots or stars and of decreased vision.
• Vision may be completely blocked if chamber is completely filled.
• Blood can be noted in the coloured or dark part (iris) of the eye.

On-Field Assessment

• Have the athlete sit down.
• Test the vision in both eyes. Cover up one eye and have the athlete read anything available. Test each eye separately.
• Inspect the eye. Look at the bone structure, the sclera (white portion), the iris (coloured portion), and the pupil (the dark circle in the middle of the eye). Note swelling, cuts, or differences between eyes.
• Test the pupils. Have the athlete focus on a distant object then shine a light into each pupil. The pupils should constrict (become smaller).
• Check eyeball movement. The eyeball moves in six different directions. Have the athlete follow your finger to see if the eye moves in all directions. Note any double vision.

On-Site Management

Cover Eyes. Patches should be placed over both eyes to prevent eye movement. It is necessary to cover the uninjured eye to prevent the injured eye from tracking along with the uninjured eye.

Immobilization. Any movement of the head or the eyes may increase the amount of bleeding and lead to permanent blindness.

Transport. The athlete should be transported by ambulance to a hospital. Once again, emphasis should be placed on decreasing movement of the head and neck to prevent increased bleeding.

Return to Activity

When the eye is totally healed, an opthamologist should approve return to sport, with the use of protective eye equipment.

Prevention

• A majority of eye injuries (90 percent or more) can be prevented by the use of proper protective eyewear.
• Become familiar with current guidelines and equipment designed to prevent eye injuries. Contact lenses offer no protection against eye injury. Contact lens wearers should wear the standard protective eyewear recommended for their sport in addition to contacts.

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