Hyphema : Accumulation of red blood cells within the anterior chamber
Etiology :
Blunt/lacerating trauma
Intraocular surgery
Post Nd: YAG laser for PI
Blood dyscrasias (aplastic anemia, leukemia etc)
Use of substances that alter platelet or thrombin function
Strenuous conditions (asthma, whooping cough)
Spontaneously (rubeosis iridis in vein occlusions/ Diabetic retinopathy, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, herpes zoster keratouveitis, retinoblastoma)
Grading:
Grade 0: No visible layering, but red blood cells within the anterior chamber (microhyphema)
Grade I: Less than 1/3rd of anterior chamber
Grade II: 1/3 rd to ½
Grade III: 1/2 to less than total
Grade IV: Total filling of the anterior chamber with blood.
8 ball Hyphema
If the anterior chamber is filled with dark red-black blood it is called a blackball or 8-ball hyphema. The black color is suggestive of impaired aqueous circulation and decreased oxygen concentration. This distinction is important because an eight ball hyphema is more likely to cause pupillary block and secondary angle closure.
Surgical management (AC paracentesis with irrigation and aspiration) indications:
Corneal blood staining
Significant visual deteoriation
To prevent optic atrophy (IOP > 60mmHg for >48 hours despite max medical therapy)
To prevent PAS (Hyphema <50% for 8 days)
IOP >25mmHg with total hyphema >5 days
IOP >24mmHg for >24 hours (or transient IOP >30mmHg) in patients with sickle cell disease/ trait
Image from Rajan Eye Care Hospital
Comments