Traumatic hyphema

Revision as of 23:43, 1 March 2011 by Robot (talk | contribs)

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==


  • Elevation of the head
  • Eye shield
  • Pharmacologic control of pain and emesis
  • Bed rest
  • 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==


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

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