Medical interventions for traumatic hyphema

Abstract

BackgroundTraumatic hyphema is the entry of blood into the anterior chamber (the space between the cornea and iris) subsequent to a blow or a projectile striking the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g., corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may lead to permanent impairment of vision. Patients with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase. ObjectivesThe objective of this review was to assess the effectiveness of various medical interventions in the management of traumatic hyphema. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (

Is topical corticosteroid necessary in traumatic hyphema?

“…Several publications demonstrate that hyphema without further complications has a good visual acuity prognosis and no intervention had a significant effect on visual acuity. And poor visual acuity is generally related to lens or posterior segment lesions [4,8,[14][15][16][17].…”

“…In patients with hyphema, IOP can raise in acute phase because of trabecular meshwork blockage by clot, red blood cells, or inflammatory debris [3,14,18,19]. And also high dose steroids may suppress phagocyctic activity which may lead to observations such as clot, red blood cells, inflammatory debris or increased deposition of material in the juxtacanalicular meshwork of eyes [20,21].…”

Canine Secondary Glaucomas

“…91 Management of underlying conditions, such as coagulopathies or systemic hypertension, is essential. Treatment with antiinflammatories (topical or systemic steroids or NSAIDs) is also likely warranted, although attention should be paid to the potential for NSAIDs to exacerbate bleeding.…”

Wilderness Medical Society Practice Guidelines for Treatment of Eye Injuries and Illnesses in the Wilderness

“…Therefore, this condition in the wilderness requires emergent evacuation. 42 There is no difference between ambulation and complete rest on the risk of secondary hemorrhage or time to rebleeding. 42 Despite this report, in the wilderness, based on the current pathophysiologic understanding of hemostasis, activity should be restricted to walking only.…”

“…42 Historically cycloplegics (atropine 1%, every 8 hours) and topical corticosteroids (prednisolone acetate 1%, 4 times a day) have been used to decrease inflammation and improve a patient's comfort, and should be considered for this purpose. 42 If clinical signs of increased IOP are present, such as headache, nausea, or vomiting, or if the affected globe is taut under palpation in comparison with the unaffected eye, then addition of topical or systemic IOP-lowering medications are indicated. 15 In the wilderness setting, acetazolamide may be available and can be used for this purpose at a dose of 500 mg orally twice daily.…”