Hyphema

Last updated 20.09.12

 

Index

 

Definition

-  Blood in anterior chamber of eye

 

Features

-  May appear as reddish tinge to cornea or collection at gravity dependnat part of anteroir chamber

-  Grades 1-4

-  1: <1/3 of anterior chamber

-  2: 1/3 to 1/2 anterior chamber

-  3: 1/2 to less than total anterior chamber

-  4: total anterior chamber = blackball or 8-ball hyphema

-  Most grade 1 (60%+/-), 20% grade 2, 15% grade 3

-  40% forma clot rather than a level

-  If clot in contact with cornea may leave stain

 

 

Causes

-  Trauma to eye

-  Surgery to eye

-  Spontaneous

-  Neovascularisation: DM, ischaemia

-  Neoplasm: retinoblastoma

-  Uveitis

-  Vascular anomalies

 

DDx

-  Red Eye (subconjunctival haemorrhage..): anterior chamber clear of blood, painless

-  Hypopyon: exudates in anterior chamber: whitish fluid

 

Associated S/S

-  Eye pain

-  Vision loss

-  Consider damage to other intra-occular structures

-  Iris, lens, zonules, retina, optic nerve..

 

Complications

-  Permant visual impairment

-  Increased IOP (30%+/-): glaucoma, optic atrophy

-  Rebleeding: poorer prognosis for full visual recovery

-  Posterior synechiae (adhesion)

-  Peripheral anterior synechiae (adhesion)

-  Corneal blood staining

 

Ix

-  Eye Exam

-  Intraoccular pressure: Tonopen

-  Slit lamp examination

-  +/- Coags: INR, APTT

-  +/- sickle cell Ix

-  Gonioscopy by Opthalmologist: >5 days post

 

Mx

-  Opthalmology R/V

-  Resorption

-  Avoid reinjury

-  Head elevation: facilitates resolution, allows blood to settle anteriorly

-  Eye shield/patch

-  Avoidance of blood thinners: aspirin, Warfarin, Enoxaparin

-  +/- surgical evacuation

-  +/- steroids: D/W Opthalmologist

-  +/- Tranexamic Acid (traumatic)

-  Analgesia: avoid Aspirin

-  Paracetamol +/- Codeine

 

 

 

References

 

Pic: www.kellogg.umich.edu/theeyeshaveit/trauma/hyphema.html