Ocular trauma

Question 1

What is hyphema?

Answer 1

Blood in the anterior chamber of the eye

Hyphema is particularly associated with trauma.

Question 2

What is the main risk to sight associated with hyphema?

Answer 2

Raised intraocular pressure due to blockage of the angle and trabecular meshwork with erythrocytes

Question 3

What is the recommended management for hyphema?

Answer 3

Urgent referral to an ophthalmic specialist for assessment and management

Question 4

What is the required patient positioning for those with hyphema?

Answer 4

Strict bed rest

Question 5

Why is strict bed rest required in hyphema cases?

Answer 5

Excessive movement can redisperse blood that had previously settled

Question 6

How often should isolated hyphema cases be reviewed initially?

Answer 6

Daily ophthalmic review and pressure checks

Question 7

What condition should be assessed for in cases of hyphema?

Answer 7

Orbital compartment syndrome, e.g. secondary to retrobulbar haemorrhage

Question 8

Is hyphema considered an ophthalmic emergency?

Answer 8

True

Question 9

List some features of orbital compartment syndrome.

Answer 9

• Eye pain/swelling
• Proptosis
• ‘Rock hard’ eyelids
• Relevant afferent pupillary defect

Question 10

What is the urgent management procedure for orbital compartment syndrome?

Answer 10

Urgent lateral canthotomy (before diagnostic imaging)