Hyphema

Hyphema is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Blood in anterior chamber (AC) of the eye (between iris and cornea)
  • Hyphema: Grossly visible layering of blood
  • Microhyphema: Suspended RBCs visible by slit lamp only
  • Genetics:
    • Genetic predisposition is related to hereditary blood dyscrasias (see below)

Etiology

  • Blunt trauma: Most common (70–80%)
  • Anteroposterior compression of the globe with simultaneous equatorial globe expansion causing rupture of iris stromal/ciliary body vessels
  • Penetrating trauma: Direct injury to stromal vessels or sudden ocular decompression
  • Spontaneous: Less common, lower incidence of complications:
    • Tumors:
      • Melanoma
      • Retinoblastoma
      • Xanthogranuloma
      • Metastatic tumors
    • Blood dyscrasias:
      • Hemophilia
      • Leukemia
      • Thrombocytopenia
      • von Willebrand disease
    • Blood thinners: Aspirin, Coumadin, heparin, Pradaxa
    • Neovascularization of iris: In proliferative diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, carotid stenosis
    • Postsurgical: Cataract extraction, trabeculectomy, pars plana vitrectomy

ALERT
In children with no clear history of trauma, suspect child abuse

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Basics

Description

  • Blood in anterior chamber (AC) of the eye (between iris and cornea)
  • Hyphema: Grossly visible layering of blood
  • Microhyphema: Suspended RBCs visible by slit lamp only
  • Genetics:
    • Genetic predisposition is related to hereditary blood dyscrasias (see below)

Etiology

  • Blunt trauma: Most common (70–80%)
  • Anteroposterior compression of the globe with simultaneous equatorial globe expansion causing rupture of iris stromal/ciliary body vessels
  • Penetrating trauma: Direct injury to stromal vessels or sudden ocular decompression
  • Spontaneous: Less common, lower incidence of complications:
    • Tumors:
      • Melanoma
      • Retinoblastoma
      • Xanthogranuloma
      • Metastatic tumors
    • Blood dyscrasias:
      • Hemophilia
      • Leukemia
      • Thrombocytopenia
      • von Willebrand disease
    • Blood thinners: Aspirin, Coumadin, heparin, Pradaxa
    • Neovascularization of iris: In proliferative diabetic retinopathy, retinal vein occlusion, retinal artery occlusion, carotid stenosis
    • Postsurgical: Cataract extraction, trabeculectomy, pars plana vitrectomy

ALERT
In children with no clear history of trauma, suspect child abuse

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