Trauma
Hyphema
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Hyphema
, Anterior Chamber Hemorrhage
Definitions
Hyphema
Bleeding in the anterior chamber of the eye
Causes
Blunt
Eye Injury
(most common)
Injury to the iris root (outer edge of the iris where it meets the
Sclera
)
Subsequent bleeding arises from the iris blood vessels
Post-surgical
Spontaneous bleeding without injury history
Leukemia
Lymphoma
Child Abuse
Symptoms
Eye Pain
Blurred Vision
Exam
Blood layers as in a pool in the inferior aspect of the anterior chamber
Determine amount of bleeding (height of Hyphema)
Total Hyphema (8 ball Hyphema) completely obscures pupil
Microscopic Hyphema may be subtle
Red Blood Cell
s in anterior chamber may only be seen floating on
Slit Lamp
exam
Evaluate for
Globe Rupture
Intraocular Pressure
High pressure suggests blood clogging the trabecular drainage
Labs
Sickle Cell preparation in non-caucasian patients
Perform even in
Trauma
tic cases (this is emphasized by ophthalmologists)
Significantly worse outcomes (even for
Sickle Cell Trait
)
Management
Restrict movement
Bed rest with head of bed at 30 degrees
No reading
Avoid pressure on eye (risks dislodged clot and rebleeding)
Fox metal shield (or small paper cup) to cover injured eye
Prevents further
Eye Injury
Immediate Referral to Ophthalmology
Consider inpatient management
Systemic aminocaproic acid (AMICAR)
Outpatient management
Topical Corticosteroid
s
Consider in
Consultation
with ophthalmology
Atropine
1% single dose
Results in complete paralysis of the iris muscle for 2 weeks
Other
Cycloplegic
s do not completely paralyze the iris and require frequent re-dosing
Glaucoma
agent (if
Intraocular Pressure
increased)
Intraocular Beta Blocker
(e.g.
Timolol
) - Preferred first-line agent
Intraocular Carbonic Anhydrase Inhibitor
(
Trusopt
,
Azopt
)
Intraocular Alpha-2 Adrenergic Agonist
(
Lopidine
,
Alphagan
)
Management
Sickle Cell Anemia
Requires emergent management
Risk of Eye vaso-
Occlusion
Risk of acute angle closure
Glaucoma
Risk of
Vision Loss
Admit all
Sickle Cell Anemia
patients with Hyphema (even small Hyphemas)
Raise head of bed
Consult ophthalmology
Agents that may be used in
Sickle Cell Disease
and Hyphema
Beta Blocker
s
Clonidine
Avoid medications in
Sickle Cell Disease
that cause sickling
Acetazolamide
(
Diamox
)
Diuretic
s
Mannitol
Topical beta agonists (e.g.
Epinephrine
)
Complications
Blindness
Results from Hyphema rebleeding (from dislodged clot)
Cornea
l blood staining
Glaucoma
Retina
l Injury
Prognosis
Small Hyphemas tend to heal well without complication
Risk factors for complications and worse outcomes
Sickle Cell Anemia
(including
Sickle Cell Trait
)
Large Hyphema
Rebleeding
References
Majoewsky (2012) EM:Rap 12(1): 4
Glassberg and Weingart in Majoewsky (2012) EM:Rap 12(9): 3-4
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