Purpose: To eliminate the continuing so-called "controversy" regarding, and opposition to, the specific medical management of traumatic hyphema (TH) with systemic antifibrinolytic agents including aminocaproic acid (ACA) and tranexamic acid (TXA) and steroids (prednisone); to illuminate the role of topical steroids.
Method: Review of all (English language) studies since 1950 of these medical treatments of TH, and contemporary no specific medical treatment controls.
Results: The difference between the average rebleeding rate in the specifically medically treated group, 4.89%, and that rate in the untreated group, 13.02%, was statistically a true difference due not to chance but to the difference in therapy with a probability of <0.0001 by Chi Square Test, Yates Corrected Chi Square Test and Fisher's Exact Test. This was also true individually respectively and with identical probabilities of p=<0.0001 for systemic steroids, topical steroids, ACA and TXA. Combined topical steroids and systemic ACA or TXA did not further improve results.
Conclusion: Preventing rebleeding episodes remains a major treatment objective in the clinical management of TH. This is best accomplished by the Yasuna systemic steroid No Touch or No Touch PLUS treatment protocol, the only treatment protocols consistently yielding zero rebleed rates in non-Scandinavian populations.