Hyphaema

Hyphaema : blood in the anterior chamber. When clot fills the anterior chamber it is called an 8-ball hyphema.

History:

• symptoms: pain, blurred vision, loss of vision 
• injury: blunt trauma? what happened ? when ? how ?
• Bleeding diathesis: disorders, medications, history of sickle cell disease 
• Use of eye protection 

Examination:

• Visual acuity - variable 
• External examination: check for concomitant head and facial injury 
• pupillary reflex
• Tonometry 
• Slit lamp examination if there is one available 
• Fundoscopy and red reflex 

Investigation and management

• Oral analgesia and topical cycloplegics for comfort, Consider antiemetics.
• Remain upright 
• Apply an eye shield (how to pad an eye)
• Avoid blood thinners
• Treat secondary glaucoma
• Surgical evacuation 
• review by an opthalomologist within 24 hours 

Hospital admission criteria

• non compliant patients
• children 
• increased IOPs
• sickle cell disease
• bleeding diathesis or blood dyscrasia 

Follow up and discharge advice

• examine by an ophthalmologist on a daily basis (or on day 3 on a microhyphema)
• refrain from strenous physical activities for 1 week after the initial injury or a rebleed

Complications

• rebleeding 
• glaucoma
• corneal staining
• traumatic iritis 

References: 

- life in the fast lane