This is an extreme form of hyphemia in which the bleeding in the eye is so bad that the entire eyeball turns black or dark brown from blood clots. Thus, the eye resembles a miniature black billiard ball. This condition is generally caused by a severe blow to the head or a direct blow to the eye (such as by being struck by a baseball or racquetball, two common ways people end up with this condition).

This condition almost always requires surgery to correct.