Traumatic hyphema: Difference between revisions
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==Background== | ==Background== | ||
*Typically casued by blunt trauma to the orbit | |||
*Main concern = rebleeding and elevated intraocular pressure | |||
* Typically casued by blunt trauma to the orbit | *Worse around days 3-5 | ||
* Main concern = rebleeding and elevated intraocular pressure | *Can result in permanent vision loss | ||
* Worse around days 3-5 | |||
* Can result in permanent vision loss | |||
==Clinical Features== | ==Clinical Features== | ||
*Blood in the anterior chamber | |||
*Vision loss | |||
* Blood in the anterior chamber | *Eye pain | ||
* Vision loss | *Direct and consenual photophobia | ||
* Eye pain | |||
* Direct and consenual photophobia | |||
==Work-Up== | ==Work-Up== | ||
*Slit lamp | |||
*Check pressure once globe rupture is excluded! | |||
*Consider CT | |||
==DDx== | |||
*Ruptured globe | |||
*Retinal detachment | |||
*Rebleeding | |||
==Treatment== | |||
*Elevation of the head | |||
*Eye shield | |||
*Pharmacologic control of pain and emesis | |||
*Bed rest | |||
*No reading (accommodation may further stress injured blood vessels) | |||
*Cycloplegic | |||
*For comfort if globe rupture has been excluded | |||
*Topical steroid | |||
*Treat any underlying coagulopathy | |||
* Elevation of the head | |||
* Eye shield | |||
* Pharmacologic control of pain and emesis | |||
* Bed rest | |||
* No reading (accommodation may further stress injured blood vessels) | |||
* Cycloplegic | |||
* For comfort if globe rupture has been excluded | |||
* Topical steroid | |||
* Treat any underlying coagulopathy | |||
==Disposition== | |||
Inpatient: | Inpatient: | ||
*suspected child abuse | |||
* suspected child abuse | *bleeding dyscrasia | ||
* bleeding dyscrasia | *sickle hemoglobinopathy | ||
* sickle hemoglobinopathy | *intraocular hypertension on initial examination | ||
* intraocular hypertension on initial examination | *delayed presentation | ||
* delayed presentation | *large hyphemas (>50% anterior chamber) | ||
* large hyphemas (>50% anterior chamber) | |||
==Prognosis== | ==Prognosis== | ||
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==Source== | ==Source== | ||
UpToDate | UpToDate | ||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 08:34, 12 March 2011
Background
- Typically casued by blunt trauma to the orbit
- Main concern = rebleeding and elevated intraocular pressure
- Worse around days 3-5
- Can result in permanent vision loss
Clinical Features
- Blood in the anterior chamber
- Vision loss
- Eye pain
- Direct and consenual photophobia
Work-Up
- Slit lamp
- Check pressure once globe rupture is excluded!
- Consider CT
DDx
- Ruptured globe
- Retinal detachment
- Rebleeding
Treatment
- Elevation of the head
- Eye shield
- Pharmacologic control of pain and emesis
- Bed rest
- No reading (accommodation may further stress injured blood vessels)
- Cycloplegic
- For comfort if globe rupture has been excluded
- Topical steroid
- Treat any underlying coagulopathy
Disposition
Inpatient:
- suspected child abuse
- bleeding dyscrasia
- sickle hemoglobinopathy
- intraocular hypertension on initial examination
- delayed presentation
- large hyphemas (>50% anterior chamber)
Prognosis
| Grade | Ant Chamber Filling |
Nl Vision Prognosis |
| I | <33% | 90% |
| II | 33-50% | 70% |
| III | >50% | 50% |
| IV | 100% | 50% |
Source
UpToDate