Hyphema

Aka: Hyphema, Anterior Chamber Hemorrhage

1. Definition
   1. Bleeding in the anterior chamber of the eye
2. Causes
   1. Blunt Eye Injury (most common)
      1. Injury to the iris root (outer edge of the iris where it meets the Sclera)
      2. Subsequent bleeding arises from the iris blood vessels
   2. Post-surgical
   3. Spontaneous bleeding without injury history
      1. Leukemia
      2. Lymphoma
      3. Child Abuse
3. Exam
   1. Determine amount of bleeding (height of Hyphema)
   2. Evaluate for Globe Rupture
   3. Intraocular Pressure
      1. High pressure suggests blood clogging the trabecular drainage
4. Labs
   1. Sickle Cell preparation in non-caucasian patients
      1. Perform even in traumatic cases (this is emphasized by ophthalmologists)
      2. Significantly worse outcomes (even for Sickle Cell Trait)
5. Complications
   1. Blindness
      1. Results from Hyphema rebleeding (from dislodged clot)
   2. Corneal blood staining
   3. Glaucoma
6. Prognosis
   1. Worse prognosis in Sickle Cell Anemia
7. Management
   1. Restrict movement
      1. Bed rest with head of bed at 30 degrees
      2. No reading
      3. Avoid pressure on eye (risks dislodged clot and rebleeding)
   2. Fox metal shield (or small paper cup) to cover injured eye
   3. Immediate Referral to Ophthalmology
   4. Consider inpatient management
      1. Systemic aminocaproic acid (AMICAR)
   5. Oupatient management
      1. Atropine 1% single dose
         1. Results in complete paralysis of the iris muscle for 2 weeks
         2. Other Cycloplegics do not completely paralyze the iris and require frequent re-dosing
      2. Glaucoma agent (if Intraocular Pressure increased)
         1. Intraocular Beta Blocker (e.g. Timolol) - Preferred first-line agent
         2. Intraocular Carbonic Anhydrase Inhibitor (Trusopt, Azopt)
         3. Intraocular Alpha-2 Adrenergic Agonist (Lopidine, Alphagan)
8. References
   1. Majoewsky (2012) EM:RAP 12(1): 4