Management of the Patient with Hyphema

Abstract

Bleeding into the anterior chamber (hyphema) occurs most commonly after blunt or penetrating injuries, but also in a number of other settings. Complications include elevation of intraocular pressure and its consequences as well as corneal blood staining, and vision loss from associated injuries. The risk of complications is believed to be higher in patients with sickle cell disease. Although there is no consensus on the use of various medications in patients with hyphema, most ophthalmologists agree that cycloplegics, topical steroids, and anti-glaucoma medications are important and prevent complications such as elevated intraocular pressure, posterior synechiae, and possibility of rebleeds. Management of pediatric patients as out or inpatients and the restriction of their level of activity continue to be debated, as is the use of systemic anti-fibrinolytics and oral steroids. It is critical to identify associated ocular, orbital, or other accompanying injuries. The surgical evacuation of blood from the anterior chamber is considered and performed in cases in which the hyphema does not resolve and intraocular pressure is significantly elevated.