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Jeffrey SooHoo, Emily McCourt; Intraocular Pressure and Traumatic Hyphema in Children. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5676.
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To evaluate the relationship between traumatic hyphema and intraocular pressure (IOP) in a pediatric population
This is a retrospective review of all 138 patients seen in the emergency department at Children’s Hospital Colorado between September 1, 2003 and December 31, 2011 and diagnosed with traumatic hyphema. The medical record of each patient was reviewed to determine the mechanism of injury and the incidence of secondary glaucoma and ocular hypertension.
The majority of hyphemas (122/138, 88%) occurred in male patients; the mean age for all patients was 10.1 years (range 1-19). Sixteen patients (12%) did not have initial IOP measurements due to age, cooperation, or concern for globe trauma. The mean IOP at presentation for the remaining 122 patients was 19.9mmHg (range 6-51) with a median of 18.5mmHg. Thirty-three patients without sufficient follow-up were excluded from the remainder of the data analysis, leaving 89 patients in this review. Thirty-three of these patients (37%) had elevated IOP (>21mmHg) in the injured eye either at presentation or during follow-up. Patients with increased IOP were either observed closely or treated with topical and/or oral ocular hypertensive medication(s) at the discretion of the treating physician. Twenty-three of these patients (70%) had normal IOP off treatment at one month following their injury. Six patients required prolonged medical treatment and four patients required surgical intervention for persistently elevated IOP. Two patients underwent anterior chamber washout within one week of injury for large hyphemas and associated ocular hypertension. Two patients required glaucoma filtering surgeries less than three months post-trauma. The mechanism of injury for three of the four patients needing surgery was a plastic or metal projectile (BB) from an air-gun. Half of the patients with IOP >40mmHg at presentation (n=4) required surgery. The average initial IOP of patients requiring surgery was 35mmHg compared to 19.4mmHg for patients not requiring surgery (p<0.001).
Elevated IOP is a common occurrence after pediatric trauma resulting in hyphema. The majority of patients respond well to medical management. IOP >40mmHg at presentation increases the odds of needing surgical intervention. High-velocity plastic or metal pellets are the most likely mechanism for traumatic hyphema requiring surgery.
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