What is the role of irrigation in the treatment 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

Irrigation by a single or double needle technique has the advantage of a small incision. The authors prefer using a diamond blade and entering at the 1-o'clock position in the right eye and at the 11-o'clock position in the left eye. The entry should be through clear cornea. The irrigating needle should extend just through the corneal endothelium, and a slow push-pull maneuver with the single needle technique washes out the erythrocytes from the anterior chamber clot, often leaving the fibrin matrix. To reduce the likelihood of rebleeding during the operative procedure, care should be undertaken not to produce violent alterations in the anterior chamber pressure. If rebleeding does occur, an air bubble can be effectively introduced for tamponade. After a 5-minute wait, irrigation maneuvers can be resumed. Using the single or double needle technique, the surgeon must be particularly careful to have direct visualization of the anterior chamber.

This technique has some disadvantages. Sometimes, maintaining the position of the needle tip in the anterior chamber during the procedure is difficult. A hazardous situation is created when the collar-button type of formed clot occupies both the anterior and posterior chambers. This produces pupillary block with anterior displacement of the iris-lens diaphragm.


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