Traumatic hyphema: Difference between revisions
| Line 23: | Line 23: | ||
==Treatment== | ==Treatment== | ||
#General | #General | ||
#Elevation of the head | ##Elevation of the head | ||
#Eye shield | ##Eye shield | ||
#Pharmacologic control of pain and emesis | ##Pharmacologic control of pain and emesis | ||
#Bed rest | ##Bed rest | ||
#No reading (accommodation may further stress injured blood vessels) | ##No reading (accommodation may further stress injured blood vessels) | ||
#Cycloplegic | ##Cycloplegic | ||
#For comfort if globe rupture has been excluded | #For comfort if globe rupture has been excluded | ||
##Topical steroid | ##Topical steroid | ||
Revision as of 08:35, 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
- General
- 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