Hyphema

How is hyphema treated?

Ambulation should be allowed with limitation of exercise and a patch and shield for the injured eye. If analgesics are required for pain relief, acetaminophen (Tylenol) with or without codeine, depending on the severity of the pain, is preferred. -Aspirin should be avoided as its antiplatelet effects increase the incidence of re-bleeding Elevating the head of the bed 30-45 degrees when sleeping or resting facilitates settling of the hyphema in the inferior anterior chamber and aids in classifying the hyphema. Aminocaproic acid (ACA) may be useful in the prevention of recurrent hemorrhages.

How are traumatic hyphemas classified?

Grade 1: layered blood occupying less than 1/3 of the anterior chamber. -58% Grade 2: layered blood filling 1/3 to 1/2 of the anterior chamber. -20% Grade 3: layered blood filling 1/2 to less than the total of the anterior chamber. -14% Grade 4: total clotted blood, often referred to as blackball or 8-ball hyphema. -8%

What is hyphema?

Hyphema is defined as the presence of blood within the aqueous fluid of the anterior chamber. The most common cause of hyphema is trauma.

What is the etiology of hyphema?

Hyphema is usually the result of a projectile or deliberate blow that hits the exposed portion of the eye despite the protection of the bony orbital rim. Hyphema related to surgical procedures on the eye may occur intraoperatively or postoperatively. Rarely, spontaneous hyphemas may occur secondary to neovascularization (e.g. diabetes mellitus, ischemia), ocular neoplasms, uveitis and vascular anomalies.

What are complications of hyphema?

In addition to glaucoma, the four most significant complications include posterior synechiae, peripheral anterior synechiae, corneal blood-staining and optic atrophy.

What is the relationship between intraocular pressure and hyphema?

Increased intraocular pressures may accompany hyphemas of any size. The early period of elevated intraocular pressure is probably the result of trabecular plugging by erythrocytes and fibrin.

What is the appropriate workup for hyphema?

Lab studies -In African American patients, a sickle cell prep should be ordered if a hyphema is seen because the presence of a hyphema in patients with sickle cell trait or disease can produce significant ocular complications. Imaging studies -Infrequently, a CT scan may be necessary to rule out an intraocular tumor or a foreign body Gonioscopy -Examination of the angle structures is critical to understanding the extent of the blunt trauma precipitating a hyphema. This can be delayed until after the critical 5-day, high-risk, re-bleed period.

What is the epidemiology of hyphema?

Males are involved in 75% of traumatic hyphema cases.

What is the prognosis of hyphema?

Rebleeding into the anterior chamber results in a markedly worse prognosis. Secondary hemorrhage occurs in approximately 25% of all patients with hyphema. The incidence of secondary hemorrhage is higher in hyphemas classified as Grades 3 and 4. The success of hyphema treatment, as judged by the recovery of visual acuity, is good in approximately 75% of patients. The severity of the trauma is frequently related to the final visual outcome.

When is surgical intervention warranted for hyphema?

Surgical intervention is rarely indicated for hyphemas that occupy less than one half of the anterior chamber. Most hyphemas, including total hyphemas, should be medically treated for the first 4 days. Surgical intervention is usually indicated on or after the fourth day. Indications include: -4 days since onset of total hyphema and the hyphema has not cleared -Microscopic corneal bloodstaining -Hyphemas filling greater than 50% of the anterior chamber retained longer than 8-9 days