Traumatic hyphema

Background

• Refers to blood in the anterior chamber
• Typically casued by blunt trauma to the orbit
• Can result in permanent vision loss
• Rebleeding
  • Worse around days 3-5
  • Elevated intraocular pressure may lead to vision loss
  • Earliest symptom is decreased vision

Diagnosis

• Blood in anterior chamber
  • May only see difference in color of irises if pt is supine
• 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

1. Elevate head of bed
2. Eye shield
3. Pharmacologic control of pain and emesis
4. Consult ophtho regarding:
   1. Dilation of pupil to avoid "pupillary play"
      1. Constriction and dilation movements of the iris in response to changing lighting
      2. Can stretch the involved iris vessel causing additional bleeding
   2. Use of topical alpha-agonists and/or acetazolamide to decrease intraocular pressure
5. No reading (accommodation may further stress injured blood vessels)
6. Cycloplegic
   1. For comfort if globe rupture has been excluded
7. Topical steroid
8. Treat any underlying coagulopathy

Disposition

1. Should be made by the ophthalmologist after examining the pt
   1. Hyphemas <33% of ant chamber are frequently managed as outpatients

Prognosis

Grade	Ant Chamber Filling	Nl Vision Prognosis
I	<33%	90%
II	33-50%	70%
III	>50%	50%
IV	100%	50%

See Also

• Ruptured Globe
• Retinal Detachment

Source

• UpToDate
• Tintinalli