This document discusses traumatic hyphema, which is bleeding into the anterior chamber of the eye following an eye injury. It can be caused by blunt trauma, surgery, or spontaneously from conditions like tumors or blood clotting issues. Symptoms include blurred vision, pain and photophobia. Treatment involves protecting the eye, preventing further bleeding with medications, and sometimes surgically removing blood if pressure rises too high. Goals are to prevent secondary glaucoma and damage to vision.

1. SANTANINA MUSAHARI, R.N.

2. — Frank bleeding into the anterior chamber
following contusion of the globe.
—Disruption of blood vessels in the iris or ciliary
body
—This blood usually does not clot
—w/ bed rest, a red fluid meniscus is form

3. • separates the cornea
from the lens, both
of which work
together to focus
light onto the retina.
The anterior chamber
is full of clear fluid
called aqueous
humor, which is
important for the
health of the cornea.

4. Blunt Trauma
Intraocular surgery
Lacerating trauma
Penetrating and perforating injury
It also occurs spontaneously w/o any
trauma, usually neovascularization, tumor of
eye (Retinoblastoma), uveitis or vascular
anomalies
Use of medicine which impair blood clotting
such as aspirin and analagesic

5. • Traumatic Hyphema occurs most often
from a tear in the anterior surface of the
ciliary body, with resultant disruption of
the major arterial circle of the iris,
arterial branches to the ciliary body or
vein coursing between the ciliary body
and episcleral venous plexus

6. • There are 2 suggested mechanism of
hyphema formation
– 1. direct contusive force cause mechanical
tearing of blood vasculature of iris and or
angle
– 2. Concussive trauma creating rapidly rising
intravascular pressure with in the vessels
resulting in rupture of vessels

7. -
Blurring of vision
Pain
Photophobia
Tearing

8. Grade
Size of Hyphema
0
I
No layered blood
circulating red blood cells
only
Less than 1/3
II
1/3 to 1/2
III
1/2 to less than total
IV
Total

10. • Injured eye should be protected with a
shield for 1 to 2 weeks after injury.
• Systemic Aminocaproic acid ( Amicar
[100mg/kg of body weight every 4 hrs
orally for 5 days], an inhibitor of
fibrinolysis, may prevent early clot
retraction within injured intraocular
vessel and reduced the possibility of
secondary hemorhhage.
• Spontaneous Recovery usually occur if the
AC in not entirely filled w/ blood

11. • Minor rises in IOP
– Treated w/ topical timolol and systemic
acetazolamide.
• Surgical Indication:
– Inc. IOP of >50 mmHg
– Persistently (5 to 7 days) high pressure
– Early blood staining of the cornea
• Simple removal of small amount of aqueous
humour (Anterior Chamber Paracentesis) or
Irrigation of AC may be effective

12. – Clots should never be removed by means of forceps
due to difficulty distinguishing clot from iris.
– Vitrectomy irrigator aspirator maybe used to
aspirated the blood.
• Inserted through the corneoscleral limbus
• Care must be taken not to injure the endothelium, iris
or lens.
• General anesthesia is usually desirable due to
difficulty anesthetizing the congested eye
• If IOC is increase, give IV mannitol to reduced the
pressure before incision into AC

13. • Blood in the anterior chamber is not by it self
necessarily harmful. However, if the quantities
are sufficient it may obstruct the outflow of
Aqueous humour, resulting In Glaucoma
• The original hyphema, w/c is often relatively
minute and absorbed in 2 to 3 days, may be
followed by more severe bleeding 3 to 5 days
after the original injury. A secondary Glaucoma
may occur immediately.

14. • Secondary glaucoma
– May cause optic atrophy, corneal blood staining
and adhesion between the peripheral iris and
anterior chamber angle ( peripheral anterior
synechiae.
– When anterior chamber is filled w/
blood, prolong secondary glaucoma causes
staining of the cornea.
• Corneal stroma is infiltrated by hemosiderin, w/c
causes deep yellowish green opacity of the cornea

15. • Aspirin and related analgesics w/c impair
blood clotting should not be used to
relieve pain
– Acetaminophen may be substituted.