Hyphema: The Daily PANCE Blueprint

The answer is B, Glaucoma

If the trabecular network becomes obstructed from the hyphema then glaucoma may occur.

• Cataracts may be caused by increasing age (most commonly), toxins, systemic disease, smoking, and hereditary, but not by hyphemas.
• Retinal detachment may occur from trauma but not from a hyphema.

Pearls

• Hyphema refers to grossly visible blood in the anterior chamber of the eye (between the cornea and the iris)
• The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
• The mechanism of injury varies by age ⇒ Usually from blunt/penetrating trauma. Bleeding results from tears in the vessels of the ciliary body or iris (trauma) or direct damage to iris (penetrating injury).
• Assault, baseball, hockey, paintballs, airbags, etc.

Diagnosis

Traumatic hyphema is a clinical diagnosis that is made based upon history of eye trauma and characteristic findings during an ophthalmologic examination

• Orbital CT in patients with a suspected open globe or concern for serious orbital injury
• Ophthalmology consult

Treatment

All patients with a traumatic hyphema warrant prompt evaluation by an ophthalmologist to provide expertise in comprehensive eye examination, including intraocular pressure measurement.

• Frequently blood is reabsorbed over a period of days to weeks
• Eye shield – To avoid further injury to the affected eye, an eye shield should be worn at all times until the hyphema resolves or for at least one week 
• Elevate the head of the bed at 30 degrees all the time
• Topical glucocorticoid eye drops
• Daily monitoring of intraocular pressure is a cornerstone in the management of traumatic hyphema
• NSAIDs are contraindicated as they may lead to increased bleeding into the anterior chamber
• Surgery if high pressure or persistent bleeding