Traumatic hyphema: 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
- Professor of Pediatrics and Emergency Medicine
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical 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. 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".)
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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- INDICATIONS FOR OPHTHALMOLOGY CONSULTATION OR REFERRAL
- INITIAL MANAGEMENT
- OPHTHALMOLOGIC MANAGEMENT
- Initial therapy
- - Monitoring of intraocular pressure
- - Limitation of activity
- - Eye shield
- - Cycloplegia
- - Glucocorticoid eye drops
- - Determining sickle cell status
- Patients with rebleeding
- Patients with intraocular hypertension
- Surgical clot evacuation
- TRAUMATIC GLAUCOMA
- SUMMARY AND RECOMMENDATIONS