eMedicine Specialties > Ophthalmology > Intraocular Pressure
Glaucoma, Hyphema: Follow-up
Updated: Dec 28, 2007
Follow-up
Further Inpatient Care
- The clot is least adherent to the surrounding tissues on the fourth day following the injury; this is the preferred time for surgery, when it is needed.
- Hyphema may be washed out or removed with a vitrectomy instrument.
- In some cases, a trabeculectomy may be necessary to control IOP.
Further Outpatient Care
- Despite clearing the hyphema, IOP may remain high.
- In these cases, perform serial gonioscopic examinations to detect angle recession, synechia, and sustained blood clot.
- Treat the appearance of the optic nerve and visual field.
- Vitreous hemorrhage and retinal breaks might complicate a case even if the hyphema clears.
Inpatient & Outpatient Medications
- If the patient tolerates antiglaucoma medications for controlling IOP, keep these medications.
- As the hyphema clears and IOP decreases, discontinue medications in a stepwise fashion, starting with the one that has the most systemic adverse effects.
Complications
- Corneal bloodstaining is one complication of long-standing hyphema in association with glaucoma.
- Both hemosiderin and hemoglobin collect in the stroma and give the cornea a yellowish appearance.
- It usually spontaneously resolves in years. When there is suspicion of corneal bloodstaining in the early stages, the hyphema should be cleared surgically. Washing out the anterior chamber long after the incident has been found to be useful to clear bloodstaining.
- Anterior segment structures can become difficult to visualize.
- Glaucoma may lead to optic atrophy; this is especially true in patients with sickle cell. Always consider early surgical intervention in resistant cases. A long period of high IOP (ie, 50 mm Hg lasting longer than 5 d) is dangerous.
- The most severe complication of hyphema is not the initial bleed but rather a rebleed, which is usually seen within 72 hours following the initial trauma. The rebleeding rate is 10-20%.
- Hyphema resulting from a rebleed usually is more extensive than that seen with the initial trauma.
- Rebleeding may present as total hyphema with blood filling the entire anterior chamber, often called 8-ball hyphema. Such significant hemorrhages often lead to elevated IOPs and corneal bloodstaining. They also are more likely to require surgical care.
- Peripheral anterior synechia is another complication and is associated with larger hyphemas and longer durations.
Prognosis
- Prognosis depends on the size of the hyphema. Patients with a small-sized hyphema have a good prognosis with simple management and treatment. Patients whose eyes undergo rebleeding have a poor prognosis because they have a larger sized hyphema and are also more likely to have higher IOP.
- Patients who undergo surgery for anterior chamber wash-out or for ocular injury repair following initial trauma also have a poorer prognosis.
- Total hyphema is difficult to treat, and the visual outcome is usually poor.
- In some studies, final vision was found better than 20/50 in almost 75% of all hyphema cases.
Patient Education
- Promote public awareness about wearing goggles in high-risk sports or work environments.
- For excellent patient education resources, visit eMedicine's Eye and Vision Center and Glaucoma Center. Also, see eMedicine's patient education articles Hyphema (Bleeding in Eye), Glaucoma Overview, Glaucoma FAQs, and Understanding Glaucoma Medications.
Miscellaneous
Medicolegal Pitfalls
- Failure to identify patients with sickle cell
- Failure to order sickle cell preps in all cases of spontaneous or traumatic hyphema in high-risk ethnic groups
More on Glaucoma, Hyphema |
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| References |
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References
Campbell D, Shields MB, Liebmann JM. Ghost cell glaucoma. In: Ritch R, Shields B, Krupin T, eds. The Glaucomas. Vol 2. 1989:1239-1247.
Culom RD Jr, Chang B, eds. Hyphema and microhyphema. In: The Wills Eye Manual. 1994:32-6.
Drug Facts and Comparisons Staff. Drug Facts and Comparisons. 1999.
Herschler J, Cobo M. Trauma and elevated intraocular pressure. In: Ritch R, Shields B, Krupin T, eds. The Glaucomas. Vol 2. 1989:1225-1237.
Rahmani B, Jahadi HR. Comparison of tranexamic acid and prednisolone in the treatment of traumatic hyphema. A randomized clinical trial. Ophthalmology. Feb 1999;106(2):375-9. [Medline].
Shields MB. Glaucomas associated with intraocular hemorrhage and glaucomas associated with ocular trauma. In: Textbook of Glaucoma. 1992:381-399.
Shingleton BJ, Hersh PS. Traumatic hyphema. In: Eye Trauma. 1991:104-116.
Walton W, Von Hagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. Jul-Aug 2002;47(4):297-334. [Medline].
Hersh P, Zagelbaum B, Shingleton B, Kenyon K. Anterior segment trauma. In: Albert D, Jakobiec F, Azar D, Gragoudas E, eds. Principles and Practice of Ophthalmology. 2nd ed. Philadelphia: WB Saunders; 2000:5201-5221.
Further Reading
Keywords
hyphema, microhyphema, hemorrhage in the anterior chamber
