Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Traumatic hyphema: Epidemiology, anatomy, and pathophysiology

INTRODUCTION

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. If ruptured globe is suspected, then emergent consultation with an ophthalmologist is critical to ensure preservation of 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 hemoglobinopathy, or bleeding tendency.

This review covers the definition, epidemiology and pathophysiology of traumatic hyphema. Diagnosis and treatment are covered elsewhere. (See "Traumatic hyphema: Clinical features and management".)

DEFINITION

  • Hyphema refers to grossly visible blood in the anterior chamber of the eye (picture 1).
  • Microhyphema describes dispersed red blood cells in the anterior chamber that do not layer out to form a gross fluid level (figure 1).

EPIDEMIOLOGY

Incidence — The annual incidence of traumatic hyphema has been estimated at 12 injuries per 100,000 population, with males being affected three to five times more frequently than females [1-4]. Up to 70 percent of traumatic hyphemas occur in children, with a peak incidence between 10 and 20 years of age [1,3,4].

Required use of appropriate ocular protection can significantly decrease the incidence of traumatic eye injury during recreational sports in children [5,6].

          

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: May 2013. | This topic last updated: Sep 7, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Kennedy RH, Brubaker RF. Traumatic hyphema in a defined population. Am J Ophthalmol 1988; 106:123.
  2. Agapitos PJ, Noel LP, Clarke WN. Traumatic hyphema in children. Ophthalmology 1987; 94:1238.
  3. Edwards WC, Layden WE. Traumatic hyphema. A report of 184 consecutive cases. Am J Ophthalmol 1973; 75:110.
  4. Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol 2002; 47:297.
  5. Brandt MT, Haug RH. Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg 2001; 59:1462.
  6. Pashby T. Eye injuries in Canadian amateur hockey. Can J Ophthalmol 1985; 20:2.
  7. Sankar PS, Chen TC, Grosskreutz CL, Pasquale LR. Traumatic hyphema. Int Ophthalmol Clin 2002; 42:57.
  8. Napier SM, Baker RS, Sanford DG, Easterbrook M. Eye injuries in athletics and recreation. Surv Ophthalmol 1996; 41:229.
  9. Rahmani B, Jahadi HR, Rajaeefard A. An analysis of risk for secondary hemorrhage in traumatic hyphema. Ophthalmology 1999; 106:380.
  10. Spoor TC, Kwitko GM, O'Grady JM, Ramocki JM. Traumatic hyphema in an urban population. Am J Ophthalmol 1990; 109:23.
  11. Alfaro DV 3rd, Jablon EP, Rodriguez Fontal M, et al. Fishing-related ocular trauma. Am J Ophthalmol 2005; 139:488.
  12. Motley WW 3rd, Kaufman AH, West CE. Pediatric airbag-associated ocular trauma and endothelial cell loss. J AAPOS 2003; 7:380.
  13. Cavallini GM, Lugli N, Campi L, et al. Bottle-cork injury to the eye: a review of 13 cases. Eur J Ophthalmol 2003; 13:287.
  14. Brouzas D, Charakidas A, Papagiannakopoulos D, Koukoulomatis P. Elastic cord-induced ocular injuries. Injury 2003; 34:323.
  15. Kratz A, Levy J, Cheles D, et al. Airsoft gun-related ocular injuries: novel findings, ballistics investigation, and histopathologic study. Am J Ophthalmol 2010; 149:37.
  16. Thach AB, Ward TP, Hollifield RD, et al. Ocular injuries from paintball pellets. Ophthalmology 1999; 106:533.
  17. Farr, AK, Fekrat, S. Eye injuries associated with paintball guns. Int Ophthalmol 1998-1999; 22:169.
  18. Alliman KJ, Smiddy WE, Banta J, et al. Ocular trauma and visual outcome secondary to paintball projectiles. Am J Ophthalmol 2009; 147:239.
  19. Read JE, Goldberg MF. Blunt ocular trauma and hyphema. Int Ophthalmol Clin 1974; 14:57.
  20. HORVEN I. ERYTHROCYTE RESORPTION FROM THE ANTERIOR CHAMBER OF THE HUMAN EYE. Acta Ophthalmol (Copenh) 1963; 41:402.
  21. Read, J, Goldberg, MF. Comparison of medical treatment for traumatic hyphema. Trans Am Acad Ophthalmol Otolaryngol 1974; 78:799.
  22. Cohen SB, Fletcher ME, Goldberg MF, Jednock NJ. Diagnosis and management of ocular complications of sickle hemoglobinopathies: Part V. Ophthalmic Surg 1986; 17:369.
  23. Fong LP. Secondary hemorrhage in traumatic hyphema. Predictive factors for selective prophylaxis. Ophthalmology 1994; 101:1583.
  24. Lai JC, Fekrat S, Barrón Y, Goldberg MF. Traumatic hyphema in children: risk factors for complications. Arch Ophthalmol 2001; 119:64.
  25. Nasrullah A, Kerr NC. Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema. Am J Ophthalmol 1997; 123:783.
  26. Hallet C, Willoughby C, Shafiq A, et al. Pitfalls in the management of a child with mild haemophilia A and a traumatic hyphaema. Haemophilia 2000; 6:118.
  27. Morsman CD, Holmes J. Traumatic hyphaema in a haemophiliac. Br J Ophthalmol 1990; 74:563.
  28. Crawford JS, Lewandowski RL, Chan W. The effect of aspirin on rebleeding in traumatic hyphema. Am J Ophthalmol 1975; 80:543.
  29. Ackerman J, Goldstein M, Kanarek I. Spontaneous massive vitreous hemorrhage secondary to thrombocytopenia. Ophthalmic Surg 1980; 11:636.
  30. Koehler MP, Sholiton DB. Spontaneous hyphema resulting from warfarin. Ann Ophthalmol 1983; 15:858.
  31. Lifshitz T, Yermiahu T, Biedner B, Yassur Y. Traumatic total hyphema in a patient with severe hemophilia. J Pediatr Ophthalmol Strabismus 1986; 23:80.
  32. McDonald CJ, Raafat A, Mills MJ, Rumble JA. Medical and surgical management of spontaneous hyphaema secondary to immune thrombocytopenia. Br J Ophthalmol 1989; 73:922.
  33. Aminlari A, Callahan CE. Medical, laser, and surgical management of inadvertent cyclodialysis cleft with hypotony. Arch Ophthalmol 2004; 122:399.
  34. Kageler WV, Moake JL, Garcia CA. Spontaneous hyphema associated with ingestion of aspirin and ethanol. Am J Ophthalmol 1976; 82:631.
  35. Arentsen JJ, Green WR. Melanoma of the iris: report of 72 cases treated surgically. Ophthalmic Surg 1975; 6:23.
  36. Blanksma LJ, Hooijmans JM. Vascular tufts of the pupillary border causing a spontaneous hyphaema. Ophthalmologica 1979; 178:297.
  37. Bruner WE, Stark WJ, Green WR. Presumed juvenile xanthogranuloma of the iris and ciliary body in an adult. Arch Ophthalmol 1982; 100:457.
  38. Shields CL, Ghassemi F, Tuncer S, et al. Clinical spectrum of diffuse infiltrating retinoblastoma in 34 consecutive eyes. Ophthalmology 2008; 115:2253.
  39. Calzada JI, Kerr NC. Traumatic hyphemas in children secondary to corporal punishment with a belt. Am J Ophthalmol 2003; 135:719.