Abstract
Purpose :
Acute hyphema is one of the most common ocular injuries that results in emergent ophthalmologic consultation. Associated complications, such as severely elevated intraocular pressure (IOP) and corneal blood staining, can cause vision loss. At our institution, patients are followed daily for a period of 5-7 days to ensure that re-bleeding and IOP elevations do not occur. As management strategies often vary by provider or institution, the purpose of this study is to determine at what point certain complications are most likely to occur to inform optimal management strategies.
Methods :
Retrospective chart review of all traumatic hyphemas treated at Penn State Eye Center between January 2015 and October 2020 was performed. Data collected included age, injury mechanism, initial hyphema level, baseline IOP, maximum IOP, and re-bleed date. Hyphema associated with open globes, post-operative, and spontaneous hyphemas were excluded. IOP elevations were defined as a >5 mmHg elevated in IOP from initial examination or presenting IOP of >21 mmHg. The Penn State College of Medicine Institutional Review Board reviewed the study protocol and determined it exempt from further review.
Results :
100 eyes of 100 patients met the inclusion criteria. The mean age was 27.01±20.4 (range 2-92) years and 75% were male. The most common mechanisms were high velocity projectiles (73%), blunt trauma (17%), and motor vehicle accidents (5%). The average presenting level of hyphema was 1.55±1.94 (range 0-9.7) mm. Of the 78 patients were tested for sickle cell trait, two were positive. The mean presenting IOP was 19.65±8.35 (range 7-52) mmHg and maximum IOP during the follow up period was 25.96±10.92 (range 10-64) mmHg. IOP elevations were found to occur in 26 eyes and occurred from 1 to 15 days. 38 eyes required intervention for IOP during their clinical course. Re-bleeds were found to occur in 6 eyes and occurred from 2 to 8 days.
Conclusions :
The clinical course of traumatic hyphemas is highly variable. As such, daily follow up should continue in order to diagnose re-bleeds and IOP elevations in a timely manner.
This is a 2021 ARVO Annual Meeting abstract.