Traumatic hyphema: Clinical features and management
- Christopher M Andreoli, MD
Christopher M Andreoli, MD
- Clinical Instructor in Ophthalmology
- Harvard Medical School
- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Associate Professor of Pediatrics
- Harvard Medical School
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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: Clinical features and diagnosis".)
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 .
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- CLINICAL FEATURES
- Physical examination
- - Hyphema
- - Globe rupture
- Injury to adjacent structures
- - Lens trauma
- - Angle recession
- - Synechiae
- PRIMARY EVALUATION AND MANAGEMENT
- Initial emergency assessment
- Ophthalmology consultation
- Laboratory testing
- Diagnostic imaging
- Emergency treatment
- DEFINITIVE MANAGEMENT
- Inpatient versus outpatient treatment
- Medical management
- - Limitation of activity
- - Eye shield
- - Cycloplegia
- - Topical glucocorticoids
- - Systemic glucocorticoids
- - Antifibrinolytics
- - Treatment of intraocular hypertension
- - Transcorneal oxygen
- Surgical management
- SUMMARY AND RECOMMENDATIONS