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Hyphema refers to blood in the anterior chamber of the eye.
Blood accumulates between the iris and the cornea.
Maybe associated with blurry vision and elevated eye pressure.
Hyphema may appear as a reddish tinge, or it may appear as a pool of blood at the bottom of the iris or in the cornea.
Incidence about 20 cases per 100,000 people annually.
Frequently caused by injury.
May partially or completely impair vision.
Most common causes are intraocular surgery, blunt trauma, and lacerating trauma.
May also occur spontaneously, without any inciting trauma, and are usually caused by neovascularization, tumors of the eye (retinoblastoma or iris melanoma), uveitis, or vascular anomalies. rubeosis iridis, myotonic dystrophy, leukemia, hemophilia, von Willebrand disease, and alcohol.
Hyphemas require urgent evaluation as they may result in permanent visual impairment.
May result in hemosiderosis and heterochromia, elevation of the intraocular pressure for up to 6 days.
Most resolve within 5–6 days.
Management is to decrease the risk of rebleeding within the eye, corneal blood staining, and atrophy of the optic nerve.
Small hyphemas can usually be treated conservatively by elevating the head at night, wearing a patch and shield, and controlling any increase in intraocular pressure.
Surgery may be necessary for non-resolving hyphemas.
Surgery may be needed for hyphemas that are associated with high intraocular pressure that does not respond to medication.
Surgery cleans out the anterior chamber and prevents corneal blood staining.
Elevation of the head of the bed by approximately 45 degrees settles the hyphema inferiorly and avoids obstruction of vision, and facilitates resolution.
Bed rest does not improve outcomes.
Wearing of an eye shield at night time,pprevents accidental rubbing of the eyes during sleep, which can precipitate a rebleed.
An eye patch is worn to protect the injured eye.
Aspirin and ibuprofen are avoided, because they can increase the risk of a rebleed.
Controversy over whether a steroid medication or a mydriatic agent should be used.
Vast majority resolve on their own.
Traumatic hyphema may lead to increased intraocular pressure, peripheral anterior synechiae, atrophy of the optic nerve, staining of the cornea with blood, re-bleeding, and impaired accommodation.
Secondary hemorrhage, or rebleeding of the hyphema, can worsen visual function.