Traumatic hyphema, or blood in the anterior chamber, is a common complication of blunt or penetrating injury to the eye and can result in permanent vision loss. The goals of initial assessment include recognition and characterization of the hyphema and identification of associated orbital and ocular injuries. Although discussed separately, the assessment and management are performed jointly in practice (table 1).
If ruptured globe is suspected, then emergent consultation with an ophthalmologist is critical to help preserve vision. In addition, optimal outcome following a hyphema depends on early ophthalmologic intervention focused on prevention of rebleeding and avoidance of intraocular hypertension. In most instances, patients recover with vision intact. Vision loss is more likely in patients with large hyphemas, sickle hemoglobinopathies, or bleeding dyscrasias.
This review covers the clinical features, initial and definitive management of traumatic hyphema. Epidemiology, anatomy, and pathophysiology are covered elsewhere. (See "Traumatic hyphema: Epidemiology, anatomy, and pathophysiology".)
A rapid overview summarizes the important clinical features and initial management of traumatic hyphema (table 1).
History — Vision loss and eye pain are common presenting complaints in patients with a traumatic hyphema. In addition, nausea and vomiting may accompany this injury .