UMEM Educational Pearls

Title: The Pearls and Pitfalls of Hyphema

Category: Misc

Keywords: Hyphema IOP Ophthalmology (PubMed Search)

Posted: 2/11/2009 by Ben Lawner, MS, DO (Updated: 11/22/2024)
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Hyphema is an urgent ophthalmologic condition. Due to the high risk of rebleeding and increased intra-ocular pressure, strict follow up with an ophthalmologist is warranted. SELECTED low grade hyphemas in reliable patients may be managed on an outpatient basis. Some pointers that may be helpful for the EM inservice exam:

Measurement of intra-ocular pressure (IOP) is crucial to proper treatment and prognosis.
Many drugs are available to lower IOP, these are generally used in association with opthalmologic consultation
->acetazolamide (has potential to "sickle" RBC's)
->aminocaproic acid
->B blockers
Hyphema > 5 days are associated with high incidence of synechiae formation
Avoid NSAIDs/ ASA
Eye patching, HOB (head of bed) elevation recommended
Corneal bloodstaining indicates a poor prognosis
Incidence of rebleeding estimated at 30-40%
Graded from 0-IV. Grade IV hyphemas cover the entire anteror chamber; often called, "8 ball" or "blackball" hyphema. Grade 0=only visible on slit lamp.
Trauma is most common etiology
Low IOP and trauma? ---> Rule out globe rupture!

General indications for "very urgent" ophthalmologic consultation:

Severely impaired visual acuity=greater rebleeding risk
Patient with known SCD or sickle cell trait
Visible blood staining of cornea
High grade, covering > 1/3 of anterior chamber
Delayed presentation (risk of synechiae / vision loss due to IOP)

References

Brunette D. "Ophthalmology" Marx: Rosen's Emergency Medicine. Concepts and Clinical Practice, 6th Edition. 2006:Mosby.
Naradzay J. "Approach to ophthalmologic emergencies" Med Clin North Am. 2006;90(2):305-28.
Kahn J, Robinett, DA. "Physical examination of the eye" Emerg Med Clin N Am. 2008;26:1-16
Bord SP, Linden J. "Trauma to the globe and orbit" Emerg Med Clin N Am 2008;26:97-123.