What Is Hyphema?
While the eye can appear red due to inflammation of the conjunctiva and tissues surrounding the eye, bleeding can occur within the eye. When red blood cells are present inside of the front portion of the eye (anterior chamber), a diagnosis of hyphema is made. Hyphema occurs when there is damage to the blood vessels of the uvea (pigmented tissues of the eye) or retina. Although we have summarized hyphema in dogs below, similar concepts apply to other small animals and horses.
Depending on the cause and degree of hyphema present, there may not be a noticeable change in comfort or appearance of the eye prior to an eye exam with an ophthalmologist. Blood may be seen inside of the eye, obstructing the normal appearance of the colored iris behind the blood. Dogs may appear comfortable or may squint, tear, or rub at their face. Dogs with hyphema most often will have decreased or absent vision in the affected eye.
What Are Some Causes of Hyphema?
Broad categories for bleeding inside of the eye include systemic hypertension, blunt trauma to the head, infectious
disease, clotting abnormalities, toxicities and cancer. A common cause of hyphema is a retinal detachment. A retinal detachment can occur as a result of many of the previously listed causes or can occur due to auto-immune disease or can occur for an unknown reason (idiopathic). Retinal detachment can also occur secondary to intraocular inflammation following intraocular surgery. Of the possible infectious diseases which can lead to bleeding inside of the eye, tickborne illnesses can alter platelet function. A known rodenticide ingestion could possibly lead to bleeding inside of the eye as well.
What Tests Can Be Performed To Determine A Cause?
Since there are many systemic diseases which can lead to hyphema, various diagnostic tests could be recommended to discover the underlying cause of bleeding inside of the eye. These tests are recommended not only to stop bleeding and treat inflammation inside of the eye, but also to protect a dog’s systemic health and organ function. Tests which are initially recommended include blood pressure measurement in the office, and routine systemic blood work to look at platelet level and to screen for signs of anemia or infection. Infectious disease tests may be recommended based on a dog’s travel history or risk level. An ultrasound of the eye is a noninvasive test which can be performed in the office and can help us to determine whether a dog has a retinal detachment, or evidence of a tumor inside of the eye. Additional diagnostic tests such as chest x-rays, abdominal ultrasound or blood clotting tests may be recommended based on initial test results and response to treatment.
What Are Some Treatments For Hyphema?
Treatment of hyphema includes topical and oral anti-inflammatory medications. Dogs may be started on glaucoma drops if they are at risk of developing secondary glaucoma. If a tumor or cancer are suspected, oral anti-inflammatory medications may not be started initially since these therapies can interfere with cancer diagnosis and treatment.
What Should You Do If You Notice Hyphema Or Your Pet Is Diagnosed with Hyphema?
If your pet is diagnosed with hyphema during their eye exam, your ophthalmologist will discuss these possible causes and the best course of diagnostic tests and treatments to pursue. Prognosis for vision in an affected eye depends on the underlying cause of hyphema and response to therapy.
Other types of bleeding in the eye such as corneal bleeding (stromal hemorrhage) or retinal bleeding (retinal hemorrhage or petechia) can have very similar underlying causes as hyphema. If you suspect that there is bleeding inside of your pet’s eye, your ophthalmologist can diagnose the location of bleeding and discuss options for diagnostics and treatments with you.