What is the prognosis of hyphema?

Updated: Jan 18, 2019
  • Author: David L Nash, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

It is important to recognize that the prognosis of visual recovery is directly related to the following 3 factors, as follows:

  • Amount of associated damage to other ocular structures (ie, choroidal rupture, macular scarring)
  • Whether secondary hemorrhage occurs
  • Whether complications of glaucoma, corneal bloodstaining, or optic atrophy occur

Treatment modalities should be directed at reducing both the incidence of secondary hemorrhage and the risk of corneal bloodstaining and optic atrophy.

The success of hyphema treatment, as judged by the recovery of visual acuity, is good in approximately 75% of patients. Approximately 80% of those with less than one third filling of the anterior chamber regain visual acuity of 20/40 (6/12) or better. Approximately 60% of those with a hyphema occupying greater than one half but less than total filling of the anterior chamber regain visual acuity of 20/40 (6/12) or better, while only approximately 35% of those with an initial total hyphema or a Grade 4 hyphema have good visual results. Approximately 60% of patients younger than 6 years have good visual results; older age groups have progressively higher percentages of good visual recovery.

The severity of the trauma is frequently related to the final visual outcome. Lens opacities, choroidal rupture, vitreous hemorrhage, angle-recession glaucoma, secondary macular edema, and retinal detachment are commonly associated with traumatic hyphema, compromising the final visual result. Hyphema related to any penetrating injury of the eye has a worse visual prognosis than hyphema associated with blunt trauma.

Of patients with hyphema, 14% have poor visual results from associated trauma, including such complications as glaucoma, vitreous hemorrhage, retinal detachment, choroidal rupture, or scleral rupture. Poor visual outcome in traumatic hyphema can be directly attributed to the hyphema in 11% of patients [27, 11] ; the poor visual outcome is usually the result of secondary hemorrhage associated with optic atrophy or corneal bloodstaining.

For excellent patient education resources, visit eMedicineHealth's Eye and Vision Center. Also, see eMedicineHealth's patient education articles Hyphema (Bleeding in Eye) and Eye Injuries.


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