Traumatic hyphema: Difference between revisions
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==Background== | ==Background== | ||
*Typically casued by blunt trauma to the orbit | *Typically casued by blunt trauma to the orbit | ||
*Main concern | *Main concern is rebleeding and subsequent elevated intraocular pressure | ||
*Worse around days 3-5 | *Worse around days 3-5 | ||
*Can result in permanent vision loss | *Can result in permanent vision loss | ||
==Diagnosis== | ==Diagnosis== | ||
*Blood in | *Blood in anterior chamber | ||
*Vision loss | *Vision loss | ||
*Eye pain | *Eye pain | ||
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==Work-Up== | ==Work-Up== | ||
*Slit lamp | *Slit lamp | ||
*Check pressure once globe rupture is excluded | *Check pressure once globe rupture is excluded | ||
*Consider CT | *Consider CT | ||
| Line 33: | Line 33: | ||
==Disposition== | ==Disposition== | ||
Admit for: | |||
*Suspected child abuse | |||
* | *Bleeding dyscrasia | ||
* | *Sickle hemoglobinopathy | ||
* | *Intraocular hypertension on initial examination | ||
* | *Delayed presentation | ||
* | *Large hyphema (>50% anterior chamber) | ||
* | |||
==Prognosis== | ==Prognosis== | ||
{| border="1" | {| border="1" | ||
| Grade | | Grade | ||
Revision as of 00:17, 25 October 2011
Background
- Typically casued by blunt trauma to the orbit
- Main concern is rebleeding and subsequent elevated intraocular pressure
- Worse around days 3-5
- Can result in permanent vision loss
Diagnosis
- Blood in anterior chamber
- Vision loss
- Eye pain
- Direct and consenual photophobia
Work-Up
- Slit lamp
- Check pressure once globe rupture is excluded
- Consider CT
DDx
- Ruptured Globe
- Retinal Detachment
- Rebleeding
Treatment
- Elevation of the head
- Eye shield
- Pharmacologic control of pain and emesis
- Bed rest
- No reading (accommodation may further stress injured blood vessels)
- Cycloplegic
- For comfort if globe rupture has been excluded
- Topical steroid
- Treat any underlying coagulopathy
Disposition
Admit for:
- Suspected child abuse
- Bleeding dyscrasia
- Sickle hemoglobinopathy
- Intraocular hypertension on initial examination
- Delayed presentation
- Large hyphema (>50% anterior chamber)
Prognosis
| Grade | Ant Chamber Filling |
Nl Vision Prognosis |
| I | <33% | 90% |
| II | 33-50% | 70% |
| III | >50% | 50% |
| IV | 100% | 50% |
See Also
Source
UpToDate