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Traumatic hyphema: Management

Authors
Christopher M Andreoli, MD
Matthew F Gardiner, MD
Section Editors
Richard G Bachur, MD
Jonathan Trobe, MD
Maria E Moreira, MD
Deputy Editor
James F Wiley, II, MD, MPH

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. Once life-threatening injuries are addressed, 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 an orbital compartment syndrome or open globe is suspected, then emergent consultation with an ophthalmologist is critical to help preserve vision. In addition, optimal outcome following a hyphema depends upon 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 initial and definitive management of traumatic hyphemas. Clinical features and diagnosis of traumatic hyphemas are discussed separately. (See "Traumatic hyphema: Clinical features and diagnosis".)

APPROACH

A rapid overview summarizes the important clinical features and initial management of traumatic hyphema (table 1).

The clinician should first address life-threatening and immediate vision-threatening conditions before proceeding with specific treatment of a traumatic hyphema as follows:

                 

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 21 00:00:00 GMT+00:00 2016.
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References
Top
  1. Mowafi HA, Aldossary N, Ismail SA, Alqahtani J. Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. Br J Anaesth 2008; 100:485.
  2. Sankar PS, Chen TC, Grosskreutz CL, Pasquale LR. Traumatic hyphema. Int Ophthalmol Clin 2002; 42:57.
  3. Brandt MT, Haug RH. Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg 2001; 59:1462.
  4. Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol 2002; 47:297.
  5. Pollock T, Laliberté I, Wu J, Lyons C. Traumatic hyphema and immune thrombocytopenic purpura: late rebleeds associated with low platelet count. Can J Ophthalmol 2008; 43:717.
  6. Wilker SC, Singh A, Ellis FJ. Recurrent bleeding following traumatic hyphema due to mild hemophilia B (Christmas disease). J AAPOS 2007; 11:622.
  7. Wright KW, Sunalp M, Urrea P. Bed rest versus activity ad lib in the treatment of small hyphemas. Ann Ophthalmol 1988; 20:143.
  8. Fong LP. Secondary hemorrhage in traumatic hyphema. Predictive factors for selective prophylaxis. Ophthalmology 1994; 101:1583.
  9. Ng CS, Strong NP, Sparrow JM, Rosenthal AR. Factors related to the incidence of secondary haemorrhage in 462 patients with traumatic hyphema. Eye (Lond) 1992; 6 ( Pt 3):308.
  10. Agapitos PJ, Noel LP, Clarke WN. Traumatic hyphema in children. Ophthalmology 1987; 94:1238.
  11. Crouch ER Jr, Crouch ER. Management of traumatic hyphema: therapeutic options. J Pediatr Ophthalmol Strabismus 1999; 36:238.
  12. Romano PE, Robinson JA. Traumatic hyphema: a comprehensive review of the past half century yields 8076 cases for which specific medical treatment reduces rebleeding 62%, from 13% to 5% (P<.0001). Binocul Vis Strabismus Q 2000; 15:175.
  13. Yasuna E. Management of traumatic hyphema. Arch Ophthalmol 1974; 91:190.
  14. Rynne MV, Romano PE. Systemic corticosteroids in the treatment of traumatic hyphema. J Pediatr Ophthalmol Strabismus 1980; 17:141.
  15. Pollard ZF. No rebleeds in 250 cases of traumatic hyphema with the Yasuna "No Touch" protocol. Binocul Vis Strabismus Q 2000; 15:250.
  16. Spoor TC, Hammer M, Belloso H. Traumatic hyphema. Failure of steroids to alter its course: a double-blind prospective study. Arch Ophthalmol 1980; 98:116.
  17. Rahmani B, Jahadi HR. Comparison of tranexamic acid and prednisolone in the treatment of traumatic hyphema. A randomized clinical trial. Ophthalmology 1999; 106:375.
  18. Farber MD, Fiscella R, Goldberg MF. Aminocaproic acid versus prednisone for the treatment of traumatic hyphema. A randomized clinical trial. Ophthalmology 1991; 98:279.
  19. Hyphema and microhyphema. In: The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, 5th edition, Ehlers JP, Shah CP. (Eds), Lippincott, Williams & Wilkins, Philadelphia 2008. p.19.
  20. Gharaibeh A, Savage HI, Scherer RW, et al. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev 2013; :CD005431.
  21. Crouch ER Jr, Frenkel M. Aminocaproic acid in the treatment of traumatic hyphema. Am J Ophthalmol 1976; 81:355.
  22. Kraft SP, Christianson MD, Crawford JS, et al. Traumatic hyphema in children. Treatment with epsilon-aminocaproic acid. Ophthalmology 1987; 94:1232.
  23. Berríos RR, Dreyer EB. Traumatic hyphema. Int Ophthalmol Clin 1995; 35:93.
  24. Karkhaneh R, Naeeni M, Chams H, et al. Topical aminocaproic acid to prevent rebleeding in cases of traumatic hyphema. Eur J Ophthalmol 2003; 13:57.
  25. Pieramici DJ, Goldberg MF, Melia M, et al. A phase III, multicenter, randomized, placebo-controlled clinical trial of topical aminocaproic acid (Caprogel) in the management of traumatic hyphema. Ophthalmology 2003; 110:2106.
  26. Crouch ER Jr, Williams PB, Gray MK, et al. Topical aminocaproic acid in the treatment of traumatic hyphema. Arch Ophthalmol 1997; 115:1106.
  27. Benner JD. Transcorneal oxygen therapy for glaucoma associated with sickle cell hyphema. Am J Ophthalmol 2000; 130:514.
  28. Shiuey Y, Lucarelli MJ. Traumatic hyphema: outcomes of outpatient management. Ophthalmology 1998; 105:851.
  29. Witteman GJ, Brubaker SJ, Johnson M, Marks RG. The incidence of rebleeding in traumatic hyphema. Ann Ophthalmol 1985; 17:525.
  30. Edwards WC, Layden WE. Traumatic hyphema. A report of 184 consecutive cases. Am J Ophthalmol 1973; 75:110.
  31. Read JE, Goldberg MF. Blunt ocular trauma and hyphema. Int Ophthalmol Clin 1974; 14:57.
  32. Read J. Traumatic hyphema: surgical vs medical management. Ann Ophthalmol 1975; 7:659.
  33. Bakri SJ, Peters GB 3rd. Sympathetic ophthalmia after a hyphema due to nonpenetrating trauma. Ocul Immunol Inflamm 2005; 13:85.
  34. Campbell DG. Ghost cell glaucoma following trauma. Ophthalmology 1981; 88:1151.
  35. Kennedy RH, Brubaker RF. Traumatic hyphema in a defined population. Am J Ophthalmol 1988; 106:123.