Traumatic hyphema: Difference between revisions
(Created page with "==Background== Rebleeding and elevated intraocular pressure = main concern. == == ==Work-Up== Slit lampCheck pressureConsider CT ==DDx== Ruptured globeRetinal detachment...") |
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* 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 | |||
== == | == == | ||
| Line 10: | Line 22: | ||
Slit | * Slit lamp | ||
* Check pressure once globe rupture is excluded! | |||
* Consider CT | |||
==DDx== | |||
Ruptured | * 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: | Inpatient: | ||
* suspected child abuse | * suspected child abuse | ||
* bleeding dyscrasia | * bleeding dyscrasia | ||
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Grade Ant Chamber Nl Vision | Grade Ant Chamber Filling Nl Vision Prognosis | ||
I <33% 90% | I <33% 90% | ||
II 33-50% 70% | II 33-50% 70% | ||
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UpToDate | |||
Revision as of 23:43, 1 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