Hyphema

Question 1

RBCs in AC

Answer 1

Hyphema

Question 2

8 ball hyphema

Answer 2

The whole AC is filled with blood

Question 3

Most common cause of hyphema

Answer 3

Trauma

-make sure to look for additional signs of trauma

Question 4

If hyphema appears to be idiopathic (esp in AA or Mediterranean)

Answer 4

Order sickledex to screen for sickle cell anemia/trait

-also consider clotting disorders (CBC, PT/PTT)

Question 5

What should never be done if someone presents with a hyphema

Answer 5

Never do gonio or scleral depression

• esp if trauma related
• increased risk of rebleeds
• perform gonio after resolution

Question 6

___% of traumatic hyphema have angle recession

Answer 6

60

Question 7

Managment of hyphema

Answer 7

Avoid blood thinners (Tylenol is safe)
Bed rest with head elevated 30 degrees=decreased risk of corneal blood staining/increased IOP
Consider aminocaproic acid=decreased risk of rebleeds
-cycloplegics for pain

Question 8

Additional signs of trauma with hyphema possible

Answer 8

Iris sphincter tears 
Iridodialysis 
Traumatic cataract 
Lens subluxation 
Vossius ring 
Commotio retinae 
Angle recession

Question 9

Commotio retinae

Answer 9

Disruption of the RPE and PR outer segments due to trauma

• it appears as a grey white discoloration of the retina; it is known as berlins edema if it is in the macula
• may have retinal hemorrhages or choroidal folds
• typically resolves within 24-48 hours without sequelae, although permanent visual acuity and/or VF loss may occur

Question 10

Sympathetic ophthalmia

Answer 10

Occurs when there is a penetrating FB to surgery. It is an immune mediated response in the fellow eye that is characterized by subretinal infiltrates (Dalen Fuchs nodules), vitritis, serous RD, and papillitis