What is the clinical presentation of postoperative hyphema?

Updated: Jan 18, 2019
  • Author: David L Nash, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Early postsurgical hyphemas can be caused by bleeding from the ciliary body, from cut ends of the Schlemm canal, from the iris or iris root, or from the corneoscleral wounds. Wounds located more posteriorly tend to bleed more.

Iris neovascularization can also result in a hyphema due to fragile iris vessels that can bleed from intraoperative manipulation.

Late-onset postcataract surgical hyphemas occur from the fine arborizing neovascular vessels that form in the inner aspect of the cataract incision site. These vessels are fragile and bleed spontaneously after minor trauma. Hyphemas in this setting may be caused by posterior chamber intraocular lens (PCIOL) haptics eroding the ciliary sulcus. Anterior chamber intraocular lens (ACIOL) haptics also may cause bleeding by chafing the iris surface.

Rubeosis, or iris neovascularization, can also be a source of late postoperative hyphema.

Uveitis-glaucoma-hyphema (UGH) syndrome related to intraocular lenses is seen weeks to months after surgery. Postoperative hyphema may also occur after laser procedures involving the iris or anterior chamber angle.

After ALT, bleeding may occur from an inadvertent laser treatment of the iris root vessel or from reflux of blood from the Schlemm canal.

After a laser iridotomy, bleeding may occur from an inadvertent laser treatment of the iris root vessel. If promptly recognized intra-operatively, the physician should apply pressure with the focusing lens to reduce the rate of bleeding and the amount of hyphema formation.

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