Traumatic Glaucoma

Question 1

What does the size of a hyphaema indicate?

Answer 1

The size of a hyphaema is a useful indicator of visual prognosis and risk of complications.

Question 2

What is the incidence of complications for a hyphaema involving less than half the anterior chamber?

Answer 2

A hyphaema involving less than half the anterior chamber is associated with a 20% incidence of complications.

Question 3

What is the final visual acuity (VA) outcome for 80% of eyes with a hyphaema involving less than half the anterior chamber?

Answer 3

A final VA of better than 6/18 in 80% of eyes.

Question 4

What is the incidence of complications when more than half the anterior chamber is involved?

Answer 4

An 80% incidence of complications.

A final visual acuity (VA) of better than 6/18 is seen in only one third of cases.

Question 5

What primarily determines the visual prognosis after an eye injury?

Answer 5

The extent of injury to the retina sustained at the time of the original injury.

Question 6

What can severe and prolonged elevation of intraocular pressure (IOP) cause?

Answer 6

Corneal blood staining and damage to the optic nerve.

Question 7

At what IOP is the optic nerve endangered?

Answer 7

IOP greater than 50 mmHg.

Question 8

When may secondary hemorrhage develop after an eye injury?

Answer 8

Within 3-5 days of the initial injury and is assoxiated with worse outcome

Question 9

What is the risk associated with patients who have sickle-cell haemoglobinopathy?

Answer 9

Increased risk of complications, especially IOP elevation due to trabecular meshwork obstruction.

Question 10

What should be excluded in the general treatment of eye injuries?

Answer 10

A coagulation abnormality, particularly a haemoglobinopathy.

Question 11

What should be done with current anticoagulant medication?

Answer 11

It should be discontinued after liaison with a general physician to assess the risk.

Question 12

What is recommended regarding activity for patients with a large hyphaema?

Answer 12

Substantially limiting activity is prudent, and the patient should remain in a sitting or semi-upright posture.

Question 13

What should be worn for protection in eye injuries?

Answer 13

A protective eye shield.

Question 14

What medications may be administered depending on the IOP?

Answer 14

Topical prostaglandins, beta-blockers, and/or a topical or systemic carbonic anhydrase inhibitor (CAI).

CAI should not be used in sickle haemoglobinopathies.

Question 15

What should be avoided in patients with eye injuries?

Answer 15

Miotics, as they may increase pupillary block and disrupt the blood-aqueous barrier.

Question 16

What is often recommended for patients with a large hyphaema?

Answer 16

Atropine to achieve constant mydriasis and reduce the chance of secondary hemorrhage.

Question 17

What may be considered under higher-risk circumstances for antifibrinolysis?

Answer 17

Systemic aminocaproic acid (ACA) or tranexamic acid.

Question 18

What procedure has been described for angle bleeding points?

Answer 18

Laser photocoagulation via a gonio-prism.

Gonioscopy should probably be deferred for 5-6 days post-injury.

Question 19

When is surgical intervention required in eye injuries?

Answer 19

In around 5% of cases, indicated by total hyphaema, IOP >50 mmHg for 2 days, or IOP >35 mmHg for 5 days.

Question 20

What does surgical intervention reduce the risk of?

Answer 20

Permanent corneal staining and optic atrophy, and prevents the development of peripheral anterior synechiae and chronic secondary glaucoma.

Question 21

What should patients be advised to avoid upon discharge?

Answer 21

Any activity with a risk of even minor eye trauma for several weeks.

Question 22

What should symptoms of a rebleed prompt?

Answer 22

Immediate review.