Hyphemia refers to the condition where blood accumulates between the black of the eye and the iris. In mild cases, it only deposits at the bottom, forming a horizontal fluid level; in severe cases, it can cover the entire pupil with a bright red color, leading to visual impairment. It is named after the bleeding between the black of the eye and the iris.

This condition is referred to by various names in classical medical texts, such as "hyphemia," "ocular hyphemia," "blood filling the pupil," and "external ophthalmopathy with hyphemia." The *Yinhai Jingwei* states: "Hyphemia occurs when toxic blood flows into the pupil's aqueous humor, resembling water flowing into a well. The clear and turbid mix, causing pain and discomfort, with a red glow filling the vision. Objects appear blurry, as if viewed through a silk screen or in a fog." The *Zhengzhi Zhunsheng* also mentions: "The pupil no longer appears black and clear but instead shows a bright red spot, which may turn purplish and turbid in severe cases. The condition is critical and urgent at this stage."

Additionally, "static blood filling the eye" refers to stagnant blood accumulating under the eyelid skin and in the white of the eye, leading to hyperemia of the ocular conjunctiva, which may turn purplish-black. This should be distinguished from hyphemia.

bubble_chart Pattern Analysis

1. Exuberant Fire in the Liver and Gallbladder︰Hemorrhage between the black of the eye and the iris, with a bright red color. In mild cases, it accumulates below, forming a horizontal fluid level; in severe cases, the black of the eye becomes entirely bright red, covering the pupil. The eyes feel distended, astringent, and painful, with turbid hyperemia of the ocular conjunctiva or ciliary hyperemia. Heat tearing occurs as if scalding water is flowing, accompanied by photophobia and difficulty opening the eyes, blurred vision as if obscured by a misty veil, or a pervasive red glow. Additional symptoms include headache, tinnitus, bitter taste in the mouth, dry throat, chest and hypochondriac distension, irritability, dark urine, constipation, a red tongue, and a wiry, rapid pulse. This condition arises from excessive heat in the liver and gallbladder, with rising qi counterflow scorching the eyes and forcing blood to recklessly extravasate, resulting in red eyes, distending pain, photophobia, scalding heat tearing, bitter taste in the mouth, dry throat, tinnitus, hypochondriac pain, irritability, dark urine, and a wiry, rapid pulse. Treatment should focus on clearing the liver and draining heat, cooling blood and stopping bleeding. The recommended formula is Gentian Liver-Draining Decoction augmented with Red Peony Root and Moutan Bark, or modified versions of the static blood flooding the eye formula.
2. Liver-kidney Yin Deficiency︰Between the black of the eye and the iris, there is static blood retention due to food. The eyeball is dry with scant tears and pain, hyperemia of the ocular conjunctiva, blurred vision, and intolerance to prolonged viewing. Accompanied by dizziness, tinnitus, soreness and weakness in the lower back and knees, tidal fever with night sweats, and nocturnal emission. The tongue tip is red, and the pulse is thin and rapid. This is often caused by excessive sexual activity or prolonged illness damaging yin, leading to yin failing to control yang, deficiency fire flaming upward, and damage to the eye collaterals, causing blood to overflow into the pupil. Hence, there is hyperemia of the ocular conjunctiva, dryness, intolerance to prolonged viewing, accompanied by dizziness, tidal fever with night sweats, soreness and weakness in the lower back and knees, nocturnal emission or premature ejaculation, and a thin, rapid pulse. Treatment should focus on nourishing yin and reducing fire, harmonizing the nutrient aspect, and stopping bleeding. The formula used is the Yin-Nourishing and Fire-Reducing Decoction with modifications. If bleeding has stopped, consider adding Ophicalcite, Salvia, and Sanqi powder to invigorate blood and resolve stasis. Hyphemia due to spleen failing to control and hyphemia due to liver and kidney yin deficiency both belong to deficiency patterns, but their accompanying symptoms can help differentiate them. Treatment should focus on tonifying the spleen to control blood, using the Returning to Spleen Decoction with modifications.
3. Spleen Failing to Control Blood︰stagnant blood accumulates between the black of the eye and the iris, and in severe cases, the black of the eye appears entirely bright red. There is distending pain in the eyeball, hyperemia of the ocular conjunctiva, visual fatigue, and blurred vision. Additional symptoms include a pale complexion, mental fatigue and lack of strength, poor appetite, loose stools, insomnia with excessive dreaming, a pale tongue, and a soggy pulse. This condition often arises from constitutional weakness of spleen and stomach qi, or prolonged illness leading to middle qi deficiency, resulting in the inability to control blood circulation. Consequently, blood fails to follow its proper pathways and spills outside the vessels, leading to blood flooding the pupil, redness in the white of the eye, weakness of the eyelid muscles causing frequent drooping, mental fatigue, poor appetite, and a soggy pulse. Clinical manifestations include...
4. Injury by Foreign Object︰Injured by blunt objects, or accidental mishaps during ophthalmic surgery, the iris collaterals are damaged, leading to blood extravasation outside the collaterals, stagnating between the black of the eye and the iris, or even a bright red patch in the black of the eye, with the pupil obscured, and the white of the eye turning purplish-black or appearing blood-filled. The eyelid is swollen, bruised, and painful, with blurred vision, a normal tongue texture, and a wiry pulse. This condition is often caused by external trauma such as blunt force impact or surgical errors, resulting in intraocular bleeding flooding the space between the iris and the black of the eye. Common symptoms include eyelid swelling, bruising, and severe eye pain making it difficult to open the eyes. If treated promptly, the condition can resolve relatively easily. Yinhai Jingwei．Regarding blood flooding the pupil, it is said: "...the blood from a traumatic injury is fresh and hot; though the flooding may be severe, it subsides quickly." However, if left untreated, the static blood may become difficult to disperse over time, and severe symptoms such as intense eyeball distending pain, hardness like stone, and splitting headaches may develop, turning into a critical condition. Treatment should focus on cooling blood and stopping bleeding, supplemented by resolving stasis, using Rhubarb RhizomaAngelica Powder with additions such as Moutan Cortex, Donkey-hide Gelatin, and Sanqi powder. If static blood persists without resolving, the approach should shift to enriching yin and pacifying the liver, activating blood to break stasis, tonifying qi to improve vision, and softening hardness to dissipate masses. Prescriptions such as the "Falling Blood and Improving Vision Decoction" can be used, with modifications including Sparganium Rhizome, Zedoary Rhizome, kelp, Prunella, raw Astragalus, and White Atractylodes Rhizome. For eyeball distending pain, the "Pain-Relieving Myrrh Powder" can be applied.

bubble_chart Documentation

1. Michuan Yanke Longmu Lun．hyphemia external ophthalmopathy: "At the initial onset of this eye condition, it was mistakenly pricked by an object, or acupuncture or moxibustion was improperly applied. Initially, one eye was affected, and subsequently, the other eye was also damaged. The pain was unbearable, and when lying down, the healthy eye rested on the pillow, causing toxic blood to flow into the healthy eye, resulting in injury."