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
- Elevate head of bed
- Eye shield
- Pharmacologic control of pain and emesis
- Consult ophtho regarding:
- Dilation of pupil to avoid "pupillary play"
- Constriction and dilation movements of the iris in response to changing lighting
- Can stretch the involved iris vessel causing additional bleeding
- Use of topical alpha-agonists and/or acetazolamide to decrease intraocular pressure
- Dilation of pupil to avoid "pupillary play"
- 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
- Should be made by the ophthalmologist after examining the pt
- 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
Source
- UpToDate
- Tintinalli