Traumatic Hyphema

Clinical Description

This is blood in the anterior chamber as a result of injury

Signs and Symptoms

• History of injury, usually blunt trauma
• Poor vision
• Blood clots visible in the anterior chamber.

Treatment

• If a child, admit in hospital and keep under observation. If left unattended, chances of a re-bleed are high resulting in intraocular pressure elevation and corneal endothelial staining
• If anterior chamber is 1/3 full in an adult, can treat as an outpatient
• If anterior chamber is >1⁄3 full, admit the patient
• Bed rest and bed should be elevated at 45°
• Dexamethasone 0.1% eye drops 6 hourly
• Cyclopentolate eye drops 8 hourly for cycloplegia
• Timolol 0.5% 12 hourly if IOP is elevated or acetazolamide (Diamox) 250mg PO 8 hourly (remember to ask about renal problems and sulphur allergy before giving acetazolamide)
• Gentamicin 0.3% eye drops 8 hourly to prevent or treat associated infection
• Analgesic of preference but avoid NSAIDs

Complications

• Corneal endothelial staining
• Glaucoma

Complications and Referral Criteria

• Full chamber hyphema
• Children with any hyphema
• Hyphema not improving after 4 days