Hyphema

Specialty: Ophthalmology.

• blood in the anterior chamber
• intraocular blood level
• hemorrhage in anterior chamber

Why it occurs

• Blunt ocular trauma of moderate or high energy (causing rupture of blood vessels in the ciliary body or iris)
• Neovascularization of the iris or rubeosis iridis (secondary to proliferative diabetic retinopathy or retinal ischemia due to venous occlusion)
• Uveitis-Glaucoma-Hyphema Syndrome (UGH, secondary to constant mechanical friction of an intraocular lens poorly positioned on the iris or ciliary body)
• Intraoperative or postoperative hemorrhagic complication of eye surgery
• Hereditary or acquired hematological disorders (sickle cell anemia or hemophilias)

Initial workup

Measurement of intraocular pressure (IOP) using Goldmann applanation tonometry or rebound tonometry (with extreme caution not to press on the eyeball); Slit lamp examination cataloging the height of the hyphema; Urgent hemoglobin electrophoresis to rule out sickle cell anemia (sickling) in patients with suspected ethnic or history, due to high risk of optic nerve ischemia from moderate IOP spikes; Delayed gonioscopy (after 3-4 weeks to assess angular recession).

Standard management

• Ciclopentolate — 1% eye drops, 1 drop every 8-12 hours, or Atropine 1% eye drops every 24 hours to maintain controlled miosis/mydriasis, immobilize the iris and ciliary body and prevent rebleeding due to pupillary contraction
• Prednisolone — 1% eye drops, 1 drop every 4-6 hours to control intraocular inflammation induced by red blood cell lysis
• Dorzolamide (2% eye drops, 1 drop every 12 hours in case of elevated intraocular pressure due to obstruction of the trabecular meshwork). *Note: The use of non-steroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid systemically is contraindicated due to the risk of increasing ocular rebleeding.*