Traumatic hyphema

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

1. Elevation of the head
2. Eye shield
3. Pharmacologic control of pain and emesis
4. Bed rest
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

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