Hyphema: Clinical Essentials
Ophthalmology High-Yield: Trauma & Emergencies
1. Causes
- Traumatic (Most Common): Blunt ocular trauma causing rupture of iris/ciliary body vessels.
- Spontaneous: Neovascularization (Rubeosis iridis in PDR), iris tumors (e.g., juvenile xanthogranuloma), or clotting disorders.
2. Clinical Features (C/F)
| Feature | Description |
|---|---|
| Signs | Blood in the anterior chamber (leveling effect). |
| Symptoms | Pain, photophobia, blurred vision. |
| Complications | Secondary glaucoma (blocked TM), corneal blood staining, and re-bleeding. |
3. Management (Rx)
- Medical (Standard): Bed rest (head elevated 30-45°), eye shield, topical cycloplegics (to rest the iris), and topical corticosteroids (to reduce inflammation).
- IOP Management: If pressure is elevated, use beta-blockers or alpha-agonists. Avoid miotics (can increase inflammation) and avoid aspirin/NSAIDs (risk of re-bleeding).
- Surgical: Indications for anterior chamber paracentesis/washout:
- Uncontrolled IOP despite maximal medical therapy.
- Corneal blood staining.
- Total hyphema persisting > 5 days.
4. NEET PG High-Yield Pearls
- “Eight-Ball Hyphema”: Total black/dark red hyphema; indicates total anterior chamber filled with clotted blood; extreme risk for secondary glaucoma.
- Sickle Cell Trait: Mandatory screening; even small hyphemas can cause massive IOP spikes due to sickling of RBCs in the trabecular meshwork.
- Re-bleed: Most likely to occur 3–5 days post-injury as the initial clot retracts.