Traumatic hyphema - Revision history

Rossdonaldson1: /* Video */

2024-04-17T20:12:31Z

Video

← Older revision		Revision as of 20:12, 17 April 2024
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	*[[Blunt orbital trauma]]		*[[Blunt orbital trauma]]

	==~~Video~~==		==External Links==
	~~{{#widget:YouTube\|id=vQG9kL7mpyA}}~~

	==References==		==References==

Cmb23 at 01:11, 2 October 2023

2023-10-02T01:11:22Z

← Older revision		Revision as of 01:11, 2 October 2023
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	*Consult ophtho regarding:		*Consult ophtho regarding:
	**Dilation of pupil to avoid '''"pupillary play"''' -constriction and dilation movements of the iris in response to changing lighting, which can stretch the involved iris vessel causing additional bleeding		**Dilation of pupil to avoid '''"pupillary play"''' -constriction and dilation movements of the iris in response to changing lighting, which can stretch the involved iris vessel causing additional bleeding
	**Use of topical α-agonists and/or acetazolamide to decrease intraocular pressure		**Use of topical α-agonists and/or acetazolamide to decrease intraocular pressure (avoid acetazolamide if the patient has sickle cell disease as this increase sickling)
	*[[Cycloplegic]] can be given for comfort and to decease pupillary play if globe rupture has been excluded. Options include:		*[[Cycloplegic]] can be given for comfort and to decease pupillary play if globe rupture has been excluded. Options include:
	**[[Tropicamide]] (Mydriacyl)		**[[Tropicamide]] (Mydriacyl)

NadavNahumi: /* Clinical Features */

2020-03-18T22:48:27Z

Clinical Features

← Older revision		Revision as of 22:48, 18 March 2020
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	*Direct and consensual photophobia		*Direct and consensual photophobia
	*[[Nausea/vomiting]]		*[[Nausea/vomiting]]
	*Hyphema grading correlates to ~~IOP~~ increase<ref>Oldham GW. Hyphema. Jan 6, 2015. http://eyewiki.aao.org/Hyphema#Differential_diagnosis</ref>		*Hyphema grading
	**Grade 0 to IV		**Grade I: ≤ 1/3 anterior chamber volume
			**Grade II: 1/3-1/2 anterior chamber volume
			**Grade III: > 1/2 anterior chamber volume
			**Grade IV: total anterior chamber volume, "eight ball hyphema"
			*Elevated grading correlates to increase in intraocular pressure<ref>Oldham GW. Hyphema. Jan 6, 2015. http://eyewiki.aao.org/Hyphema#Differential_diagnosis</ref>
	**13.5% have IOP increase in Grade I to II		**13.5% have IOP increase in Grade I to II
	**52% with IOP increase in Grade IV		**52% with IOP increase in Grade IV

ClaireLewis: /* Spontaneous hyphema (non-traumatic hyphema) */

2019-10-06T21:58:16Z

Spontaneous hyphema (non-traumatic hyphema)

← Older revision		Revision as of 21:58, 6 October 2019
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	*[[Sickle cell disease]]		*[[Sickle cell disease]]
	*Ocular or laser surgery		*Ocular or laser surgery
	*HSV, VZV uveitis		*[[HSV]], [[VZV]] [[uveitis]]
	*Neoplastic		*Neoplastic

ClaireLewis: /* Evaluation */

2019-09-19T17:31:57Z

Evaluation

← Older revision		Revision as of 17:31, 19 September 2019
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	*Assess for [[Ruptured Globe]] which is associated with high energy mechanisms (shrapnel, BB guns, paintballs, etc)		*Assess for [[Ruptured Globe]] which is associated with high energy mechanisms (shrapnel, BB guns, paintballs, etc)
	*Check intraocular pressure after [[Globe Rupture]] is excluded		*Check intraocular pressure after [[Globe Rupture]] is excluded
	*Inquire about bleeding diathesis, anticoagulant/NSAID/aspirin use		*Inquire about [[coagulopathy\|bleeding diathesis]], [[anticoagulant]]/[[NSAID]]/[[aspirin]] use

	==Management==		==Management==

ClaireLewis at 01:31, 2 September 2019

2019-09-02T01:31:21Z

← Older revision		Revision as of 01:31, 2 September 2019
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	==Background==		==Background==
	*Grossly visible blood in the anterior chamber of the eye		*Grossly visible blood in the anterior chamber of the eye
	*Typically caused by blunt trauma to the orbit		*Typically caused by [[blunt eye trauma\|blunt trauma]] to the orbit
	*Can result in permanent vision loss		*Can result in permanent [[vision loss]]
	**Outcome dependent on prevention of rebleeding and control of intraocular pressure		**Outcome dependent on prevention of rebleeding and control of intraocular pressure
	*In non-traumatic hyphema, all patients of African decent should be screened for [[sickle cell disease]] with hemoglobin electrophoresis		*In non-traumatic hyphema, all patients of African decent should be screened for [[sickle cell disease]] with hemoglobin electrophoresis
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	==Clinical Features==		==Clinical Features==
	*Vision loss		*[[Vision loss]]
	*Eye pain		*[[Eye pain]]
	*History of trauma to eye		*History of trauma to eye
	*Direct and consensual photophobia		*Direct and consensual photophobia
	*Nausea ~~and Vomiting~~		*[[Nausea/vomiting]]
	*Hyphema grading correlates to IOP increase<ref>Oldham GW. Hyphema. Jan 6, 2015. http://eyewiki.aao.org/Hyphema#Differential_diagnosis</ref>		*Hyphema grading correlates to IOP increase<ref>Oldham GW. Hyphema. Jan 6, 2015. http://eyewiki.aao.org/Hyphema#Differential_diagnosis</ref>
	**Grade 0 to IV		**Grade 0 to IV
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	**May only see difference in color of irises if patient is supine because blood layering is gravity dependent		**May only see difference in color of irises if patient is supine because blood layering is gravity dependent
	**Blood in anterior chamber only visible on slit lamp is a microhyphema		**Blood in anterior chamber only visible on slit lamp is a microhyphema
	*Vision loss / Acuity changes		*[[Vision loss]] / Acuity changes
	*Inspect the lids, lashes, lacrimal ducts, and cornea		*Inspect the lids, lashes, lacrimal ducts, and cornea
	**Corneal abrasions often co-exist		**[[Corneal abrasions]] often co-exist
	*Assess direct and consensual pupillary response for the presence of a relative afferent pupillary defect		*Assess direct and consensual pupillary response for the presence of a relative afferent pupillary defect
	*Assess for [[Ruptured Globe]] which is associated with high energy mechanisms (shrapnel, BB guns, ~~paint balls~~, etc)		*Assess for [[Ruptured Globe]] which is associated with high energy mechanisms (shrapnel, BB guns, paintballs, etc)
	*Check intraocular pressure after [[Globe Rupture]] is excluded		*Check intraocular pressure after [[Globe Rupture]] is excluded
	*Inquire about bleeding diathesis, anticoagulant/NSAID/aspirin use		*Inquire about bleeding diathesis, anticoagulant/NSAID/aspirin use

	==~~Managment~~==		==Management==
	*Elevate head of bed and upright position to layer blood by gravity, open visual field while blood resorbs		*Elevate head of bed and upright position to layer blood by gravity, open visual field while blood resorbs
	*Eye shield		*Eye shield
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	*Should be made by the ophthalmologist after examining the patient		*Should be made by the ophthalmologist after examining the patient
	**Hyphemas <33% of anterior chamber are frequently managed as outpatients		**Hyphemas <33% of anterior chamber are frequently managed as outpatients
	*Patients being managed as an outpatient should have ophthalmologist referral and consider outpatient screening for spontaneous ~~hypthemas~~ due to the association with [[sickle cell disease]] and [[hemophilia]]		*Patients being managed as an outpatient should have ophthalmologist referral and consider outpatient screening for spontaneous hyphema due to the association with [[sickle cell disease]] and [[hemophilia]]
	*Patients on anticoagulation or ~~anti-platelets~~ agents should be admitted for reversal and observation.<ref name="Brandt" />		*Patients on anticoagulation or antiplatelet agents should be admitted for reversal and observation.<ref name="Brandt" />

	===Discharge instructions===		===Discharge instructions===

Boopsiewoopsie: /* Background */

2019-05-09T15:52:30Z

Background

← Older revision		Revision as of 15:52, 9 May 2019
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	*Can result in permanent vision loss		*Can result in permanent vision loss
	**Outcome dependent on prevention of rebleeding and control of intraocular pressure		**Outcome dependent on prevention of rebleeding and control of intraocular pressure
	*In non-traumatic hyphema, all ~~Black~~ patients should be screened for [[sickle cell disease]] with hemoglobin electrophoresis		*In non-traumatic hyphema, all patients of African decent should be screened for [[sickle cell disease]] with hemoglobin electrophoresis

	[[File:Hyphema.jpeg\|thumbnail\|Hyphema, Grade II-III]]		[[File:Hyphema.jpeg\|thumbnail\|Hyphema, Grade II-III]]

Mholtz at 10:31, 18 November 2017

2017-11-18T10:31:12Z

← Older revision		Revision as of 10:31, 18 November 2017
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Retinal detachment]]

	{{Maxillofacial trauma DDX}}		{{Maxillofacial trauma DDX}}

Mholtz at 10:30, 18 November 2017

2017-11-18T10:30:17Z

← Older revision		Revision as of 10:30, 18 November 2017
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	**Outcome dependent on prevention of rebleeding and control of intraocular pressure		**Outcome dependent on prevention of rebleeding and control of intraocular pressure
	*In non-traumatic hyphema, all Black patients should be screened for [[sickle cell disease]] with hemoglobin electrophoresis		*In non-traumatic hyphema, all Black patients should be screened for [[sickle cell disease]] with hemoglobin electrophoresis

			[[File:Hyphema.jpeg\|thumbnail\|Hyphema, Grade II-III]]

	==Clinical Features==		==Clinical Features==
	~~[[File:Hyphema.jpeg\|thumbnail\|Hyphema, Grade II-III]]~~
	*Vision loss		*Vision loss
	**Earliest symptom is decreased vision
	*Eye pain		*Eye pain
	*History of trauma to eye		*History of trauma to eye
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	**13.5% have IOP increase in Grade I to II		**13.5% have IOP increase in Grade I to II
	**52% with IOP increase in Grade IV		**52% with IOP increase in Grade IV


	==Differential Diagnosis==		==Differential Diagnosis==
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	*Pharmacologic control of pain and emesis		*Pharmacologic control of pain and emesis
	*Weigh risks and benefits of stopping NSAIDs, ASA, anticoagulants		*Weigh risks and benefits of stopping NSAIDs, ASA, anticoagulants
	*If [[Glaucoma\|IOP elevated]] (>22) the treatment is similar to [[glaucoma]] management except if there is also a concern for a [[retrobulbar hematoma]] as a result of trauma.<ref>Brandt, MT. Traumatic hyphema: a comprehensive review. Journal of oral and maxillofacial surgery. 2001; Vol. 59 Issue 12 Page 1462.</ref> Topical and oral treatments include		*If [[Glaucoma\|IOP elevated]] (>22) the treatment is similar to [[glaucoma]] management except if there is also a concern for a [[retrobulbar hematoma]] as a result of trauma.<ref name="Brandt">Brandt, MT. Traumatic hyphema: a comprehensive review. Journal of oral and maxillofacial surgery. 2001; Vol. 59 Issue 12 Page 1462.</ref> Topical and oral treatments include
	**[[Acute angle-closure glaucoma#Management\|Timolol]]		**[[Acute angle-closure glaucoma#Management\|Timolol]]
	**[[Acute angle-closure glaucoma#Management\|Topical α-adrenergic agonist]]		**[[Acute angle-closure glaucoma#Management\|Topical α-adrenergic agonist]]
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	**Hyphemas <33% of anterior chamber are frequently managed as outpatients		**Hyphemas <33% of anterior chamber are frequently managed as outpatients
	*Patients being managed as an outpatient should have ophthalmologist referral and consider outpatient screening for spontaneous hypthemas due to the association with [[sickle cell disease]] and [[hemophilia]]		*Patients being managed as an outpatient should have ophthalmologist referral and consider outpatient screening for spontaneous hypthemas due to the association with [[sickle cell disease]] and [[hemophilia]]
	*Patients on anticoagulation or anti-platelets agents should be admitted for reversal and observation.<ref>Brandt~~, MT. Traumatic hyphema: a comprehensive review. Journal of oral and maxillofacial surgery. 2001; Vol. 59 Issue 12 Page 1462.<~~/~~ref~~>		*Patients on anticoagulation or anti-platelets agents should be admitted for reversal and observation.<ref name="Brandt" />

	===Discharge instructions===		===Discharge instructions===
	*No reading (accommodation may further stress injured blood vessels)		*No reading (accommodation may further stress injured blood vessels)
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	==References==		==References==
	<references/>		<references/>

	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]

Adamhaag: /* Managment */

2017-08-19T17:04:06Z

Managment

← Older revision		Revision as of 17:04, 19 August 2017
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	*Pharmacologic control of pain and emesis		*Pharmacologic control of pain and emesis
	*Weigh risks and benefits of stopping NSAIDs, ASA, anticoagulants		*Weigh risks and benefits of stopping NSAIDs, ASA, anticoagulants
	*If [[Glaucoma\|IOP elevated]] the treatment is similar to [[glaucoma]] management except if there is also a concern for a [[retrobulbar hematoma]] as a result of trauma. Topical and oral treatments include		*If [[Glaucoma\|IOP elevated]] (>22) the treatment is similar to [[glaucoma]] management except if there is also a concern for a [[retrobulbar hematoma]] as a result of trauma.<ref>Brandt, MT. Traumatic hyphema: a comprehensive review. Journal of oral and maxillofacial surgery. 2001; Vol. 59 Issue 12 Page 1462.</ref> Topical and oral treatments include
	**[[Acute angle-closure glaucoma#Management\|Timolol]]		**[[Acute angle-closure glaucoma#Management\|Timolol]]
	**[[Acute angle-closure glaucoma#Management\|Topical α-adrenergic agonist]]		**[[Acute angle-closure glaucoma#Management\|Topical α-adrenergic agonist]]