How is hyphema treated?

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

The customary treatment of patients with traumatic hyphema has included hospitalization, bed rest, bilateral patching, topical cycloplegics, topical steroids, systemic steroids, and sedation. [32] However, studies have not indicated that rigidly following this regimen is necessary to achieve acceptable therapeutic results. These studies provide evidence that no statistically significant difference exists in most areas of comparison between patients treated with bed rest, bilateral patches, and sedation and those treated with ambulation, a patch and shield on the injured eye only, and no sedation. [11, 33, 34, 35]

The authors recommend ambulation with limitation of exercise and a patch and shield for the injured eye. Sedation is recommended only in the extremely apprehensive individual. Hospitalization may be warranted in cases of severe trauma and rebleeding, when abuse is suspected, or when noncompliance to medical regimens or limitation of vigorous activity is a concern.

If analgesics are required for pain relief, acetaminophen (Tylenol) with or without codeine, depending on the severity of the pain, is preferred. The antiplatelet effect of aspirin tends to increase the incidence of rebleeding in patients with traumatic hyphema and should be strictly avoided. [20] Nonsteroidal anti-inflammatory drugs (NSAIDs) with analgesic activity, such as mefenamic acid (Ponstel) or naproxen (Aleve), share this deleterious antiplatelet effect.

In any therapeutic regimen, the injured globe requires adequate protection with a patch and shield. [36] Elevating the head of the bed 30-45° when sleeping or resting facilitates settling of the hyphema in the inferior anterior chamber and aids in classifying the hyphema. Inferior settling facilitates more rapid improvement of visual acuity, earlier evaluation of the posterior pole, and greater clearing of the anterior chamber angle. A better estimate of the decrease or increase in the amount of blood in the anterior chamber is also possible during subsequent biomicroscope examinations.


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