PANCE Blueprint EENT (7%)

Hyphema (ReelDx + Lecture)

VIDEO-CASE-PRESENTATION-REEL-DX

Hyphema Patient will present as → a 14-year-old who sustained a blunt trauma to his right eye after being struck by a baseball. He complains of blurry vision. On physical exam, you note unequal pupils, injected conjunctiva/sclera, and blood in the anterior chamber of the right eye.

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Trauma causes 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.

  • Hyphemas often occur after a blunt or penetrating trauma
  • If there is trauma you need to make sure there is no other type of injury – skull fracture, orbital fracture, etc. etc.
Hyphema with blood in the anterior chamber.

Hyphema with blood in the anterior chamber.

Orbital CT (if indicated)

  • Ophthalmology consult

Frequently blood is reabsorbed over a period of days to weeks. Treatment includes rest with the head of the bed at 30 degrees all the time

  • May use topical beta-adrenergic blockers or carbonic anhydrase inhibitors
  • NSAIDs are contraindicated as they may lead to increased bleeding into the anterior chamber
  • Surgery if high pressure or persistent bleeding
Question 1
Which of the following is a potential complication of a traumatic hyphema?
A
retinal detachment
Hint:
Retinal detachment may occur from trauma but not from a hyphema.
B
glaucoma
C
cataract formation
Hint:
Cataracts may be caused by increasing age (most commonly), toxins, systemic disease, smoking, and hereditary, but not by hyphemas.
D
chronic conjunctivitis
Hint:
Chronic conjunctivitis is not known to be associated with hyphemas.
Question 1 Explanation: 
If the trabecular network becomes obstructed from the hyphema then glaucoma may occur.
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