Hyphema

Hyphema is a serious ocular condition characterized by the accumulation of blood within the anterior chamber of the eye, the fluid-filled space between the cornea and the iris. In guinea pigs, this condition presents as visible blood pooling in the front portion of the eye, which can range from a small, barely perceptible layer settling at the bottom of the chamber to complete filling that obscures the iris and pupil entirely. This bleeding occurs when blood vessels within the eye rupture, releasing blood into a space that is normally filled only with clear aqueous humor.

Hyphema is not among the most common eye conditions in guinea pigs, but it is a significant finding that always warrants prompt veterinary attention. The condition can result from various causes including trauma, underlying systemic diseases affecting blood clotting, severe infections, and rarely, intraocular tumors. Because guinea pigs are prey animals that instinctively hide vulnerability, the injury or illness that caused the hyphema may have occurred some time before the visible blood accumulation is noticed by caregivers, making thorough investigation of the underlying cause essential.

The impact of hyphema on a guinea pig's health and quality of life can be substantial. The presence of blood in the anterior chamber can temporarily or permanently impair vision depending on the extent of bleeding and whether complications develop. Pressure within the eye may increase as blood accumulates, potentially leading to painful secondary glaucoma. The blood itself, as it breaks down, releases substances that can cause inflammation and damage to delicate intraocular structures. Additionally, the underlying cause of the hyphema may represent a significant threat to overall health requiring its own specific treatment.

Treatability of hyphema in guinea pigs depends heavily on the underlying cause and the extent of ocular damage. Cases resulting from minor trauma with small amounts of bleeding often resolve with supportive care and activity restriction, with the blood reabsorbing over days to weeks. However, hyphema from severe trauma, clotting disorders, or intraocular disease may require more intensive intervention and carries a more guarded prognosis. Early detection and prompt evaluation by an exotic veterinarian experienced with guinea pig medicine is crucial for determining the cause, assessing the extent of damage, and initiating appropriate treatment to maximize the chance of preserving vision and preventing complications.

The primary causes of hyphema in guinea pigs fall into several categories, with trauma being the most common etiology. Blunt trauma to the head or eye from falls, being stepped on, collisions with cage furniture, or rough handling can rupture delicate blood vessels within the eye. Sharp trauma from hay pokes, encounters with wire cage components, or altercations with cage mates can directly penetrate ocular tissues. In multi-guinea-pig households, fighting between incompatible individuals sometimes results in eye injuries that cause hyphema, particularly when guinea pigs are improperly introduced or housed in inadequate space.

Genetic and hereditary factors do not directly cause hyphema but may contribute to conditions that predispose guinea pigs to this complication. Some guinea pigs may inherit tendencies toward blood vessel fragility or clotting abnormalities that increase the likelihood of spontaneous bleeding or excessive hemorrhage following minor injury. Certain breeds or bloodlines may carry genes associated with systemic diseases that affect vascular integrity. However, these hereditary connections are poorly documented in guinea pigs compared to some other species, and most cases of hyphema occur in individuals without known genetic predisposition.

Environmental factors significantly influence the risk of traumatic hyphema. Cage design plays an important role—wire flooring, sharp edges, protruding screws, and poorly secured accessories create hazards that can injure eyes. Multilevel cages with ramps increase fall risk, particularly for young, elderly, or clumsy individuals. Inappropriate bedding materials with sharp components can cause eye injuries. Overcrowded housing intensifies competition and aggression, increasing the likelihood of injuries from cage mate conflicts. Housing guinea pigs with other species, such as rabbits, dramatically increases injury risk as rabbits can deliver powerful kicks.

Risk factors for hyphema extend beyond trauma to include various medical conditions. Severe hypertension, though less commonly diagnosed in guinea pigs than in some other species, can cause spontaneous rupture of ocular blood vessels. Clotting disorders, whether inherited or acquired through disease or toxin exposure, predispose guinea pigs to excessive bleeding from minor injuries. Diabetes and other metabolic diseases can weaken blood vessel walls over time. Severe infections, particularly those causing uveitis or inflammation within the eye, can damage vascular structures and lead to bleeding. Neoplastic conditions, including lymphoma and other cancers, can involve the eye directly or affect clotting mechanisms systemically.

The mechanism of hyphema development begins with disruption of blood vessel integrity within the anterior segment of the eye. The iris, ciliary body, and surrounding tissues contain numerous small blood vessels that can be damaged by trauma, inflammation, or disease processes. When these vessels rupture, blood flows into the anterior chamber and initially mixes with the aqueous humor before settling due to gravity into the characteristic layered appearance. The volume of blood that accumulates depends on the size and number of damaged vessels and whether active bleeding continues or has stopped. Secondary effects include inflammatory responses to blood breakdown products, potential formation of blood clots within the eye, and in severe cases, dangerous elevation of intraocular pressure as the normal drainage pathways become obstructed.

Early warning signs of hyphema in guinea pigs can be subtle, particularly when the bleeding is minimal or occurs gradually. Initial symptoms may include slight redness in the eye that appears different from simple conjunctival irritation, as the blood is deeper within the eye rather than on the surface. The guinea pig may show increased sensitivity to light, preferring darker areas of the cage or keeping the affected eye partially closed. Subtle behavioral changes such as decreased activity, reduced appetite, or reluctance to be handled may indicate pain or visual disturbance. Careful observers might notice a slight haziness or change in the appearance of the eye before obvious blood accumulation becomes visible.

The most recognizable common symptom of hyphema is the visible presence of blood within the eye. This typically appears as a red or dark layer at the bottom of the anterior chamber when the guinea pig holds its head upright, as blood settles due to gravity. The blood may appear bright red when fresh or darker as it begins to break down over time. In more severe cases, blood may fill a larger portion or even the entire anterior chamber, giving the eye a uniformly red or dark appearance. The normal iris color and pupil may become partially or completely obscured by the accumulated blood, depending on the severity.

Behavioral changes associated with hyphema often reflect the pain, vision impairment, and stress caused by the condition. Affected guinea pigs frequently become less active and spend more time hiding in sheltered areas of their enclosure. Changes in eating behavior are common, with some guinea pigs showing decreased appetite or difficulty locating food if vision is significantly compromised. Social behaviors may shift, with affected individuals becoming withdrawn from cage mates or showing unusual aggression due to pain and disorientation. The guinea pig may tilt or turn its head in unusual ways, attempting to compensate for visual deficits or to find positions that minimize discomfort.

Physical signs accompanying hyphema extend beyond the visible blood in the eye. The affected eye may appear swollen or bulging if intraocular pressure has increased secondary to the hemorrhage. Excessive tearing or discharge may be present, particularly if there is concurrent injury to the cornea or eyelids. The pupil of the affected eye may respond abnormally to light if blood is obscuring it or if the iris has been damaged. Squinting or holding the eye partially closed is common due to pain and light sensitivity. In cases where trauma caused the hyphema, additional injuries such as facial swelling, cuts, or bruising may be apparent.

Symptom progression of hyphema follows different patterns depending on the severity and underlying cause. Mild cases with small amounts of bleeding may show gradual clearing as the blood is reabsorbed over several days to weeks, with symptoms steadily improving. Moderate cases may initially worsen before improving as blood breakdown products cause inflammation, then gradually resolve. Severe hyphema or cases with ongoing bleeding may show persistent or worsening symptoms, with increasing blood accumulation and rising intraocular pressure. Without appropriate treatment, chronic hyphema can lead to permanent structural changes within the eye and lasting vision impairment.

Emergency symptoms requiring immediate veterinary care include complete filling of the anterior chamber with blood obscuring all internal eye structures, signs of severe pain such as constant squinting or vocalization, visible bulging of the eye suggesting dangerously elevated pressure, any penetrating injury to the eye, hyphema affecting both eyes simultaneously suggesting systemic disease, and signs of overall illness such as lethargy, complete loss of appetite, or reduced fecal output. Additionally, any hyphema associated with head trauma should be evaluated urgently to rule out more serious intracranial injury. Because guinea pigs can deteriorate rapidly when unwell, prompt veterinary evaluation is always recommended when hyphema is identified.

Initial examination of a guinea pig with suspected hyphema should be performed by a veterinarian experienced in exotic animal medicine, ideally one with ophthalmologic expertise or access to specialist consultation. The examination begins with a detailed history, including questions about when the blood was first noticed, any known trauma or incidents, cage mate dynamics, environmental setup, and overall health history. A complete physical examination assesses the guinea pig's general condition and looks for evidence of trauma elsewhere on the body. Careful examination of both eyes is performed, comparing the affected eye to the normal eye and evaluating the extent of blood accumulation, condition of surrounding structures, and any other abnormalities.

Diagnostic tests for hyphema serve multiple purposes: assessing the extent of ocular damage, evaluating for complications, and investigating potential underlying causes. Tonometry measures intraocular pressure to detect secondary glaucoma, a serious complication of hyphema that requires specific treatment. Fluorescein staining of the cornea identifies any ulceration or scratches that may have occurred along with the injury causing the hyphema. If the blood obscures direct visualization of internal structures, ultrasound examination of the eye can assess the lens, retina, and other structures for damage. Blood tests including complete blood count, biochemistry panel, and coagulation profiles help identify systemic conditions that may have caused or contributed to the bleeding.

Differential diagnosis for blood or redness within the guinea pig eye includes conditions that must be distinguished from true hyphema. Subconjunctival hemorrhage, bleeding beneath the clear membrane covering the white of the eye, can appear similar but is located outside the anterior chamber. Severe conjunctivitis or uveitis may cause reddening that mimics minor hyphema. Iris melanosis, a pigmentation change, might be mistaken for blood in some cases. In albino or pink-eyed guinea pigs, normal blood vessels may be more visible and could be confused with pathological bleeding. Certain foreign bodies or debris within the eye might have a reddish appearance. Thorough examination by a qualified veterinarian is necessary to accurately diagnose hyphema and distinguish it from these other conditions.

Confirmation of hyphema diagnosis and assessment of severity guides treatment planning and prognosis. The veterinarian will grade the hyphema based on the amount of anterior chamber filled with blood, ranging from microhyphema (blood visible only with magnification) through grade one (less than one-third filled) to grade four (complete filling or eight-ball hyphema). Documentation of whether the blood is liquid, clotted, or showing signs of reabsorption helps determine the age of the hemorrhage. Assessment of associated damage to other structures including the cornea, lens, and iris refines the prognosis. Identification of the underlying cause, when possible, is crucial for appropriate treatment and prevention of recurrence.

Emergency and immediate treatment for severe hyphema focuses on stabilizing the guinea pig and preventing further damage. Guinea pigs presenting with complete hyphema, signs of elevated intraocular pressure, or systemic illness require urgent intervention. Pain management using guinea pig-safe medications such as meloxicam provides comfort and reduces inflammation. If the guinea pig has stopped eating, assisted feeding with critical care formula is essential to prevent the development of GI stasis, which can quickly become life-threatening in guinea pigs. Activity restriction is implemented immediately to prevent rebleeding, with the guinea pig confined to a small, padded enclosure with minimal furnishings. If dangerously elevated intraocular pressure is confirmed, emergency medications to reduce pressure may be administered.

Medical management of hyphema in guinea pigs aims to reduce inflammation, prevent complications, and support reabsorption of blood. Topical anti-inflammatory medications, typically corticosteroid or non-steroidal eye drops, help control intraocular inflammation caused by blood breakdown products. If infection is present or suspected, guinea pig-safe topical antibiotics such as chloramphenicol, ciprofloxacin, or gentamicin are prescribed—it is absolutely critical to avoid penicillin-based antibiotics and other drugs known to be fatal to guinea pigs. Mydriatic agents that dilate the pupil may be used to prevent adhesions between the iris and lens. Systemic pain medication continues throughout the treatment period. If an underlying clotting disorder is identified, specific treatment such as vitamin K supplementation may be indicated.

Surgical intervention for hyphema is reserved for specific circumstances when medical management alone is insufficient. Paracentesis, or surgical drainage of blood from the anterior chamber, may be considered for severe hyphema that is not resolving with conservative treatment or is causing dangerously elevated pressure. This procedure carries significant risks and is performed only when the potential benefits outweigh the dangers. If a penetrating eye injury caused the hyphema, surgical repair of the wound may be necessary. In cases where severe damage has resulted in a blind, painful eye that cannot be saved, enucleation (surgical removal of the eye) may ultimately be the most humane option to eliminate chronic pain and prevent ongoing complications.

Supportive care is fundamental to hyphema treatment and recovery in guinea pigs. Strict activity restriction minimizes the risk of rebleeding—the guinea pig should be confined to a small space with soft bedding and no climbing opportunities for at least one to two weeks. The head should be kept elevated when possible to promote settling of blood away from vital structures, though this is difficult to enforce in guinea pigs. Maintaining excellent nutrition with vitamin C supplementation supports healing and immune function. Keeping the environment dim reduces discomfort from light sensitivity. Stress reduction through maintaining familiar companions nearby (even if not in the same enclosure during activity restriction) supports psychological wellbeing.

Alternative and complementary approaches may support conventional treatment with veterinary guidance. Cool compresses very gently applied to the closed eyelid may help reduce inflammation in the early stages. Ensuring optimal environmental humidity prevents corneal drying during healing. Some holistic practitioners suggest specific nutritional supplements to support vascular health, though these should not replace appropriate medical treatment. Maintaining the guinea pig's routine as much as possible within activity restrictions reduces stress, which supports immune function and healing.

Treatment decisions for hyphema depend on multiple factors including the severity and cause of the hemorrhage, the presence of complications such as elevated intraocular pressure, the overall health status of the guinea pig, and the response to initial therapy. Mild traumatic hyphema in an otherwise healthy guinea pig often resolves with conservative management including activity restriction, pain control, and anti-inflammatory medication. More severe cases or those associated with systemic disease require more aggressive intervention and careful monitoring. The veterinarian will develop an individualized treatment plan based on comprehensive assessment and will adjust the approach as needed based on the guinea pig's progress.

Recovery timeline for hyphema in guinea pigs varies considerably depending on the severity of the initial hemorrhage and the underlying cause. Mild cases with small amounts of blood may begin clearing within three to five days and achieve complete resolution within one to two weeks. Moderate hyphema typically requires two to four weeks for blood reabsorption, with gradual clearing from the top of the anterior chamber downward as blood settles and is absorbed. Severe hyphema may take six weeks or longer to fully clear, and some degree of permanent visual impairment or structural change may result. Throughout the recovery period, the appearance of the eye often changes day to day as blood is processed and reabsorbed.

Post-treatment care is critical for successful recovery and prevention of complications. Activity restriction must continue as directed by the veterinarian, typically for at least one to two weeks, to minimize the risk of rebleeding that would restart the recovery process. All prescribed medications must be administered on schedule for the full duration of the treatment course. Regular monitoring of the affected eye helps detect early signs of complications such as increasing pressure or developing cataracts. The guinea pig's eating habits and fecal output must be closely watched, as any decrease could indicate developing GI stasis requiring immediate intervention. Follow-up veterinary appointments allow for professional assessment of healing progress and adjustment of the treatment plan as needed.

Prognosis factors affecting recovery outcome include the initial severity of the hyphema, the underlying cause, whether complications develop, and the guinea pig's overall health status. Small amounts of blood from minor trauma carry the best prognosis, with most guinea pigs recovering full or near-full vision. Larger hemorrhages increase the risk of complications such as glaucoma, cataract formation, and permanent vision loss. Guinea pigs with underlying conditions causing the hyphema face additional challenges, and their prognosis depends partly on successful management of the primary problem. Young, healthy guinea pigs with good nutritional status and proper care tend to have better outcomes than older or debilitated individuals.

Long-term outlook for guinea pigs that have experienced hyphema depends on whether full recovery is achieved or lasting damage has occurred. Many guinea pigs with mild to moderate hyphema return to completely normal eye function and quality of life. Those with residual vision impairment typically adapt well, as guinea pigs do not rely on vision as heavily as some other species and can navigate effectively using their other senses. Some guinea pigs may be at increased risk for future eye problems, including glaucoma or cataract development in the affected eye, requiring ongoing monitoring. With appropriate care and attention, most guinea pigs that recover from hyphema enjoy good quality of life for their normal lifespan.

Primary prevention of hyphema focuses on eliminating or minimizing traumatic risks in the guinea pig's environment. Proper cage design is essential—enclosures should have solid flooring rather than wire, smooth edges without sharp corners or protrusions, and secure accessories that cannot fall or shift during normal activity. Multilevel cages should have gentle ramps with good traction rather than steep climbs, and height differences should be minimized to reduce injury severity from falls. Water bottles, food dishes, and hay racks should be positioned so guinea pigs cannot injure themselves while accessing them. Regular inspection of the cage for developing hazards such as broken components, protruding wires, or unstable structures prevents accidents before they occur.

Environmental prevention extends to factors beyond physical cage safety. Appropriate social housing prevents aggression-related injuries—guinea pigs should be properly introduced using established protocols and housed in adequate space with multiple resources to minimize competition. Guinea pigs should never be housed with rabbits, whose powerful kicks can cause serious injury. Supervised floor time in safe, enclosed areas allows exercise and exploration while preventing falls from furniture or encounters with household hazards. Handling should always be gentle and secure, supporting the guinea pig's full body weight and avoiding any situation where falling is possible.

Dietary factors in preventing hyphema relate to maintaining vascular health and supporting the body's ability to heal from minor injuries without excessive bleeding. Adequate vitamin C intake is absolutely essential for guinea pigs, as they cannot synthesize this nutrient and deficiency leads to weakened blood vessels and impaired clotting. Fresh vegetables high in vitamin C should be provided daily, with supplementation as recommended by a veterinarian. A balanced diet supporting overall health maintains the integrity of blood vessels throughout the body, including those within the eye. Fresh water must always be available, as dehydration can affect blood viscosity and vascular function.

Health maintenance practices help prevent hyphema and ensure early detection of problems that could lead to eye hemorrhage. Regular veterinary examinations, ideally every six to twelve months with an exotic-experienced veterinarian, provide professional assessment of eye health and overall condition. Routine monitoring of blood pressure, when feasible, can detect hypertension before it causes vascular complications. Any signs of illness should be addressed promptly, as certain infections and systemic diseases can predispose guinea pigs to ocular bleeding. Maintaining healthy body weight reduces strain on the cardiovascular system. Keeping stress levels low through appropriate housing, handling, and routine supports overall health and immune function.

Early intervention strategies are crucial for preventing minor eye issues from progressing to hyphema and for minimizing damage when hemorrhage does occur. Any sign of eye injury or irritation, including squinting, tearing, discharge, or behavioral changes, warrants prompt examination. If trauma is witnessed or suspected, immediate veterinary evaluation can identify problems before they become severe. Having an emergency veterinary contact established before problems arise ensures rapid access to appropriate care. Knowing basic first aid, such as keeping the guinea pig calm and confined after an injury while arranging veterinary care, can prevent additional damage in the critical early period following trauma.

Daily management for a guinea pig recovering from hyphema requires careful attention to activity level, medication administration, and monitoring. During the initial recovery phase, the guinea pig must be kept in a small, safe enclosure with minimal furnishings to prevent activity that could cause rebleeding. Medication schedules must be followed precisely, with eye drops administered as directed and oral medications given consistently. Daily observation of the eye should note the amount and appearance of visible blood, any changes in the surrounding tissues, and whether the guinea pig appears to be in pain or showing signs of vision use in the affected eye. Recording these observations helps track progress and identify any concerning changes.

Home environment modifications support healing and prevent additional injury. The recovery enclosure should have soft, dust-free bedding that won't irritate the eye, such as fleece liners or paper-based products. Lighting should be kept dim to reduce discomfort from photosensitivity. Food and water should be positioned at a convenient height and location that minimizes head movement and allows the recovering guinea pig to eat and drink easily. If the guinea pig has cage mates, they may be housed in an adjacent but separate enclosure where they can see and communicate with the affected individual without physical contact that might cause accidental injury.

Quality of life maintenance remains important throughout the recovery process. Even with activity restrictions, the guinea pig needs mental stimulation and social connection. Placing the recovery enclosure in the family's main living area keeps the guinea pig engaged with household activity. Gentle, calm interaction with caregivers provides comfort and social enrichment without physical risk. If vision is significantly impaired, maintaining consistent placement of food, water, and hiding spots helps the guinea pig navigate confidently. Hand-feeding favorite treats strengthens the bond between guinea pig and caregiver and encourages eating during recovery.

Ongoing monitoring and care continue beyond the acute recovery phase. Regular weight checks ensure the guinea pig is maintaining good nutrition throughout recovery. As the veterinarian allows increased activity, gradual reintroduction to the normal enclosure and cage mates should be supervised carefully. Long-term monitoring of the affected eye watches for delayed complications such as cataract development, glaucoma, or chronic uveitis, which may develop weeks to months after the initial injury. Scheduling regular follow-up veterinary examinations ensures professional monitoring of healing and early detection of any developing problems.

Caregiver support and resources help families navigate the challenges of managing a guinea pig with a serious eye condition. Connecting with guinea pig owner communities, both online and local, provides access to others who have faced similar situations and can offer practical advice and emotional support. Open communication with the veterinary team ensures caregivers understand the treatment plan, expected recovery timeline, and warning signs that should prompt immediate contact. Keeping a journal of the guinea pig's progress helps track healing, remember questions for veterinary appointments, and maintain treatment consistency. Recognizing and managing caregiver stress is important, as caring for an ill pet can be emotionally demanding—seeking support from fellow guinea pig enthusiasts, friends, family, or professional counseling when needed helps maintain the caregiver's wellbeing and ability to provide quality care.

Hyphema can affect guinea pigs of any breed, as it is primarily caused by trauma or systemic disease rather than breed-specific characteristics. However, certain physical traits common to some breeds may marginally influence susceptibility or outcome. Guinea pigs with prominent, protruding eyes may have slightly increased exposure of the globe to potential traumatic contact, though this is not well documented as a significant risk factor. Breeds with longer facial hair, such as Peruvian and Silkie guinea pigs, might face increased risk if hair grows into the eyes and causes rubbing or irritation that leads to self-trauma. Roan and dalmatian-patterned guinea pigs, which carry the lethal white gene complex, may have associated eye abnormalities that could theoretically affect vascular structure, though direct connection to hyphema risk is not established.

General risk considerations apply across all guinea pig breeds regardless of physical characteristics. Any guinea pig housed in an unsafe environment faces trauma risk. Guinea pigs of any breed may develop systemic conditions affecting clotting or vascular integrity that could cause or worsen hyphema. Age-related changes may increase fragility of blood vessels, potentially making senior guinea pigs more susceptible to significant bleeding from minor trauma. Individual variation in eye anatomy, vascular structure, and healing capacity exists within all breeds and may influence both susceptibility to hyphema and recovery outcomes.

Screening and prevention recommendations for breeders and caregivers focus on environmental safety and health maintenance rather than breed-specific concerns. All guinea pigs, regardless of breed, should be housed in safe enclosures designed to minimize trauma risk. Regular veterinary examinations can detect systemic health problems that might predispose to hyphema. Responsible breeders should select breeding stock free from known hereditary conditions affecting clotting or vascular health. New guinea pigs entering a household should receive thorough veterinary examination including eye assessment. Long-haired breeds require regular grooming to prevent hair from irritating the eyes and causing the rubbing that might lead to self-trauma.

Several conditions commonly co-occur with or contribute to hyphema in guinea pigs. Uveitis, inflammation within the eye, frequently accompanies hyphema and may be both a cause and a consequence of intraocular bleeding. Corneal ulceration often occurs alongside hyphema when both result from the same traumatic incident, and the ulcer requires concurrent treatment. Glaucoma, elevated intraocular pressure, can develop secondary to hyphema as blood obstructs normal fluid drainage pathways, creating a painful and vision-threatening complication. Lens luxation, displacement of the lens from its normal position, may occur with severe trauma that also causes hyphema. Retinal detachment, while difficult to detect in guinea pigs, can accompany significant ocular trauma.

Conditions with similar symptoms that might be confused with hyphema include several other causes of red or abnormal eye appearance. Severe conjunctivitis causes redness of the ocular surfaces but the blood vessels are on the exterior of the eye rather than within the anterior chamber. Subconjunctival hemorrhage involves bleeding beneath the conjunctival membrane rather than inside the eye proper. Iris prolapse, where iris tissue protrudes through a corneal wound, may create a dark appearance in part of the eye. Certain tumors involving the eye can have a reddish appearance that might initially resemble blood. Detailed examination by a qualified veterinarian is necessary to accurately distinguish these conditions.

Potential complications of hyphema if untreated or poorly managed can significantly impact long-term eye health and function. Secondary glaucoma from blood obstructing drainage pathways causes pain and progressive vision loss if pressure is not controlled. Cataract formation can occur as blood breakdown products affect lens clarity over time. Synechiae, adhesions between the iris and other structures, may form and cause chronic problems with pupil function and intraocular pressure regulation. Chronic uveitis can persist after blood is reabsorbed, causing ongoing inflammation and gradual deterioration of vision. Phthisis bulbi, shrinkage and degeneration of the eye globe, may be the end result of severe, unresolved hyphema, resulting in a blind, cosmetically altered but typically non-painful eye.