0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

OCULAR TRAUMA

Hyphema

ETIOLOGY

Blood in the anterior chamber, often secondary to trauma (see Figure 14.45)

SYMPTOMS/EXAM

■ Decreased vision

■ Photophobia

■ Pain

■ Absence of red reflex

■ Layering of blood in anterior chamber when patient sitting upright

■ “Eight ball hyphema” = 100% blood and requires urgent ophthalmology

consult.

TREATMENT

■ Rest, with elevation of HOB about 45º

■ Monitor IOP.

■ Avoid blood-thinning medications.

■ May consider cycloplegic drops and aminocaproic acid to prevent recur-

rent hemorrhage.

■ Avoid carbonic anhydrase inhibitor (diamox) in sicklers (increase sickling).

■ Ophthalmology consult

■ Patients with significant elevation in intraocular pressure typically require

admission and treatment with IV mannitol.

COMPLICATIONS

■ Acute glaucoma secondary to obstruction of aqueous humor

■ Rebleeding 2–5 days after (most common complication)

■ Corneal staining/pigmentation

FIGURE 14.44. Central retinal vein occlusion.

(Courtesy of Department of Ophthalmology, Naval Medical Center, Portsmoutn, VA as

published in Knoop KJ, Stack LB, Storrow AB. Atlas of Emergency Medicine,2nd ed.

New York: McGraw-Hill, 2002:83.)