Hyphema
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This document defines hyphaema as blood in the anterior chamber of the eye. It can result from compressive trauma that injures blood vessels in the iris, ciliary body, or trabecular meshwork. Hyphaema is classified based on etiology (traumatic, medical conditions, etc.) and severity (mild, moderate, severe). Presentation includes blurry vision, pain, and blood visible in the anterior chamber. Examination involves assessing injury, vision, pressure, and ruling out other issues. Treatment focuses on preventing increased pressure through medications, limiting activity, and sometimes surgery to remove blood if pressure remains high.
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BLUNT TRAUMA PRESENTATION.pptx
A 24-year-old male presented with blunt trauma to the right eye after being punched 1 week prior without eye protection. On examination, he had a hyphema, traumatic cataract, corneal edema, and uveitis in the right eye. He was managed conservatively with medications, close monitoring, and later referred to a vitreoretinal surgeon. Over subsequent follow ups his condition improved, though he was still advised to limit activity and continue regular monitoring. Blunt ocular trauma can cause various injuries like hyphema, cataract, uveitis, retinal tears or detachment depending on the force and location of impact. Evaluation involves examination to identify injuries and rule out perforating injuries, with
Occular emergencies
This document summarizes various ocular emergencies commonly seen in emergency departments. It discusses trauma-related emergencies like penetrating injuries, blunt injuries, burns, as well as non-trauma emergencies such as infections, glaucoma, retinal vessel occlusions, retinal detachment, and ruptured globes. It also provides details on management of specific conditions like chemical injuries, acute angle closure glaucoma, foreign bodies, orbital fractures, and ocular infections.
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The document provides an overview of proptosis (forward displacement of the eye) including its causes, clinical approach, and investigations. Some key points:
- Proptosis can be caused by inflammatory conditions like thyroid eye disease, infections like orbital cellulitis, trauma, vascular lesions, cysts, and tumors.
- The clinical approach involves taking a medical history, examining the eye and orbit, and performing investigations like CT scan and MRI to determine the underlying cause.
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- Retinal artery occlusion is usually caused by embolism and results in irreversible vision loss. Central retinal artery occlusion causes immediate vision loss while branch occlusion affects a localized area. Emergency treatment
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The document discusses neovascular glaucoma, noting the positive findings of neovascularization along the pupillary margin and diagnosing it as such. It states that the primary pathology is in the retina and lists common causes as ischemic central retinal vein occlusion, diabetes mellitus, central retinal artery occlusion, and ocular ischemic syndrome. The document advises that miotics should be avoided as medical treatment for neovascular glaucoma, instead recommending topical atropine, steroids if inflammation is present, and apraclonidine or oral acetazolamide.
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This document discusses optic disc swelling (papilledema) caused by increased intracranial pressure. It presents a case of a 35-year-old woman with severe headaches and vision issues. Examination found bilateral disc edema. CT scan revealed a brain tumor causing pressure. The patient was diagnosed with papilledema from the tumor and underwent surgery. The document then discusses the causes, presentation, stages, histopathology, and treatment of papilledema, emphasizing the importance of an eye exam for patients with headaches to identify potential intracranial issues.
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Hyphema
- 2. Definition: Blood in the anterior chamber of eye is called Hyphema.
- 3. Pathophysiology: • Compressive force to the globe or trauma can result in injury to the iris, ciliary body, trabecular meshwork, and their associated vasculature. The shearing forces from the injury can tear these vessels and result in the accumulation of blood cells within the anterior chamber. Fig; Bleeding from the ciliary body
- 4. Classification Etiological: 1. Traumatic hyphaema - most commonly blunt trauma 2. Strenuous conditions - Whooping cough, Asthma etc. 3. Blood dyscrasia -Aplastic anaemia, leukemia, hemophilia, von Willebrand disease etc. 4. Neovascularization (Rubeosis iridis) - Diabetes mellitus
- 5. Classification Etiological: 5. Miscellaneous -Intraocular tumors (retinoblastoma, iris melanoma etc.) - Vascular anomaly - juvenile xanthogranuloma (JXG) - Secondary to ocular surgery or laser -Medications with anticoagulant properties (aspirin, NSAIDs, warfarin or clopidogrel etc.)
- 6. Classification Clinical: 1. Mild or simple hyphema (2-3mm) 2. Moderate hyphema (3-5mm) 3. Severe hyphema – more than half of A/C 4. Total hyphema – A/C full of blood
- 7. Grading Hyphaemas can be graded from I-IV in the following manner:
- 8. ????
- 9. Presentation
- 10. secondary hemorrhage with raised IOP and increased risk of glaucoma Hyphaema: Small with low risk of raised IOP
- 11. Presentation • Symptoms: Symptoms can be variable depending on the etiology. Typically patients complain of blurry vision, pain, headahce, photophobia, H/O trauma. • Signs: Blood or clot or both in the AC, usually visible without a slit lamp.
- 12. Examinations/Work-up 1. History: Detailed including - - Mechanism of injury - Time of injury with time of visual loss(if any) - H/O medications (aspirin, warfarin etc.) - H/O Sickle cell disease (familial or personal?) -Any H/O coagulopathy- bleeding gums, epistaxis etc.
- 13. Examinations/Work-up 2. Ocular examinations: -Rule out any rupture globe or penetrating injuries - Visual acuity - IOP - Slit lamp examination - B-scan (gently) if A/C filled with blood -CT may be done if suspected orbital fracture
- 14. Management
- 15. Treatment: General 1. coagulation abnormality should be excluded. 2. anticoagulant medication should be discontinued 3.NSAIDs should not be used for analgesia. 4.specialist advice 5.Hospital admission 6.limiting activity 7.protective eye shield.
- 16. Treatment: Medical • Topical prostaglandins, beta-blockers and/or a topical • Miotics should also be avoided • Topical steroids • Atropine with a large hyphaema • Antifibrinolysis
- 17. Treatment: Surgical Laser photocoagulation of angle bleeding points via a gonioprism, though gonioscopy should probably be deferred for 5–6 days post- injury.
- 18. Anterior chamber paracentesis or surgical evacuation of blood • required in 5% • Indications for surgery include: 1. total hyphaema, 2. an IOP of >50 mmHg for 2 days or an IOP >35 mmHg for 5 days. • reduces the risk of permanent corneal staining and optic atrophy and prevents the occult development of peripheral anterior synechiae and chronic secondary glaucoma
- 20. THANK YOU
Editor's Notes
- Grade 0: No visible layering, but red blood cells within the anterior chamber (microhyphaema) Grade I: Layered blood occupying less than 1/3 of the anterior chamber Grade II: Blood filling 1/3 to 1/2 of the anterior chamber Grade III: Layered blood filling ½ to less than total of the anterior chamber Grade IV: Total clotted blood, often referred to as blackball or 8-ball hyphaema
- Traumatic hyphaema. (A) Small hyphaema; (B)total hyphaema; (C) corneal blood staining due to sustained high intraocular pressure associated with a total hyphaema Corneal blood staining (CBS) is a complication of hyphema and increased intraocular pressure (IOP). Spontaneous clearing can take up to 3 years, starting at the periphery.1 Factors that increase the risk of CBS include total hyphema, rebleeding, and endothelial dysfunction.2 Management options for hyphema with increased IOP include trabeculectomy, anterior chamber washout, and pharmacotherapy with topical steroids and cycloplegics.
- A coagulation abnormality, particularly a haemoglobinopathy, should be excluded. Any current anticoagulant medication should be discontinued after liaison with a general physician to assess the risk. NSAIDs should not be used for analgesia. Likewise, specialist advice should be sought regarding the management of a patient with a haemoglobinopathy, particularly before administering high-risk medication . Hospital admission may be required for a large hyphaema. Strict bed rest is probably unnecessary, but substantially limiting activity is prudent and the patient should remain in a sitting or semi-upright posture, including during sleep. A protective eye shield should be worn.
- ○ Topical prostaglandins, beta-blockers and/or a topical or systemic CAI is administered, depending on the IOP. CAI should not be used in sickle haemoglobinopathies.Miotics should also be avoided as they may increase pupillary block and disrupt the blood–aqueous barrier. ○ Occasionally a hyperosmotic agent is needed, though as with CAI and alpha-agonists a high threshold is adopted in sickle patients. ○ Topical steroids should be used since they reduce the risk of secondary haemorrhage and suppress inflammation. ○ Atropine is often recommended in patients with a large hyphaema to achieve constant mydriasis and to reduce the chance of secondary haemorrhage. ○ Antifibrinolysis with systemic aminocaproic acid (ACA) or tranexamic acid may be considered under higher-risk circumstances such as recurrent bleeding.
- • is required in around 5%. Indications for surgery include a total hyphaema, an IOP of >50 mmHg for 2 days or an IOP >35 mmHg for 5 days. Surgical intervention reduces the risk of permanent corneal staining and optic atrophy and prevents the occult development of peripheral anterior synechiae and chronic secondary glaucoma. Particular vigilance is required in patients with sickle-cell anaemia (even moderate pressure elevation can lead to optic atrophy), patients with prior glaucomatous optic neuropathy and in young children with a risk of amblyopia. A glaucoma filtration procedure may be necessary in some cases.