Good Hope Eye Clinic

Hyphaema

David Kinshuck

 

Traumatic hyphaema

  • Traumatic hyphaema general. 20/100000
  • Peak age  10-20y
  • Blunt, projectile
  • grade hyphaema..5 grades.
    • Microscopic
    • one third ac (anterior chamber), 
    • one half
    • total hyphaema 
  • Iop raised30% early...tm occlusion, clot,inflammation, rbc, pupil block, pas,,
  • Late due to trabecular meshwork damge
  • If leave hyphaema more than week, get posterior synaechiae,more pressure, corneal blood staining
  • Corneal blood staining if iop up, more blood, corneal damage
  • If total...need to remove clot otherwise it can take years...yellow discolouration and worse centrally,  amblyopia in young children
  • Secondary haemorrhage..rebleed...
  • african american high risk...sickle Trait is 10  % afrocaribeans
  • Treat:
    • elevate bed, steroids, atropine, treat pressure, check for sickle cell,
    • avoid dehydration
    • Antifibrinolytics, controversial, tranexamic acid etc
    • Wash out if iop high 60
    • or lower if sickle +ve >35
  • see Bosu ocular trauma study