Hyphema - Signs, Treatment, Causes, Forms, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Hyphema

The content of the article:

1. Causes
2. Degrees
3. Signs
4. Diagnostics
5. Treatment
6. Consequences and complications

Hyphema is a collection of blood (blood clot) in the anterior chamber of the eye. This condition is recorded more often as a consequence of trauma, but it can also occur during medical manipulations on the eyeball.

Blood clot in the anterior chamber of the eye

The incidence of hyphema is 17 cases per 100 thousand population; most often it is diagnosed in children and adolescents (up to 20 years) and elderly patients.

Normally, the anterior chamber of the organ of vision is a closed space bounded by the cornea in front and the iris behind, filled with transparent aqueous humor (intraocular fluid). The main functions of the anterior chamber are continuous drainage of the intraocular fluid, maintaining the constancy of the internal environment of the eye and ensuring the conduction of light rays, their refraction in the liquid medium.

In the case of hyphema formation, the transmission of light to the retina suffers, intraocular pressure rises, and local homeostasis is disturbed.

Causes

Factors provoking the formation of hyphema:

• traumatic effect (under the influence of a traumatic agent, a sharp displacement of the eyeball occurs, which leads to rupture of small arterial vessels going to the iris and ciliary muscle, Schlemm's canal, which transports intraocular fluid from the anterior chamber, tearing of the eye membranes);
• surgery on the eyeball (bleeding is caused by local vascular damage);
• blood diseases characterized by the pathology of the coagulation system [as a result of the failure of the coagulation processes in a number of diseases (with hemophilia, malignant diseases of the hematopoietic system, thrombocytopenia, etc.), spontaneous bleeding develops, including in the structure of the eyeball];
• somatic diseases in which the components of the vascular wall are affected (decompensated diabetes mellitus, angiopathy, pseudoglioma, collagenosis, iris rubeosis, etc.).

Hyphema is characterized by hemorrhage in the anterior chamber of the eye

The main cause of hyphema is blunt (contusion of the eyeball) or penetrating trauma; in this case, hemorrhage into the anterior chamber occurs in 30–45% or 22% of cases, respectively, in more than 70% of cases hyphema is combined with hemophthalmos.

Degrees

Depending on the amount of blood poured into the anterior chamber of the eye, several degrees of hyphema are distinguished:

1. Blood level not more than 2 mm, blood smears on the iris.
2. The level of outflowing blood is from 2 to 5 mm.
3. More than 3 mm of blood in the anterior chamber of the eye (including total hyphema).

Sometimes microhyphema is placed in a separate category, when the presence of blood is determined only by microscopy.

Signs

The manifestations of hyphema vary in the severity and extent of the clinical picture, depending on the severity of the condition:

• a feeling of veil or fog before the eyes;
• soreness of the eyeball;
• decreased visual acuity;
• photophobia;
• flashing "flies" before the eyes.

Diagnostics

In the overwhelming majority of cases, the diagnosis of the condition does not cause difficulties due to the characteristic clinical picture. However, in order to determine the degree, as well as identify concomitant pathology and possible complications, a number of studies are being carried out:

• collection of anamnestic data (a connection is established with previous trauma, surgical treatment of eye diseases, the presence of provoking diseases);
• examination of the eyeball and adjacent soft tissues;
• examination of the retina with a dilated pupil;
• biomicroscopy;
• measurement of intraocular pressure;
• two-dimensional ultrasound examination;
• computed tomography (axial and coronal projections) of the orbit and brain.

Diagnosis of hyphema does not cause difficulties due to the characteristic clinical picture

Treatment

The classical scheme of hyphema therapy provides for compulsory hospitalization of patients, although in recent years treatment is often carried out on an outpatient basis.

The main directions of treatment:

• bed rest (with a raised headboard);
• shielding the sore eye for the entire treatment period;
• drug therapy (general) - M-anticholinergics, hemostatic drugs, analgesics;
• local treatment with glucocorticosteroid agents.

Approximately one third of patients experience a relapse of bleeding on days 2-5, so the minimum hospitalization period is 5 days.

Local application of glucocorticosteroids helps with hyphema.

Mild (including micro-) hyphema usually does not require specific therapy, resolves on its own within 5-7 days.

Surgical intervention for hyphema is indicated with a significant decrease in vision, saturation of the cornea with blood, complete filling of the anterior ophthalmic chamber with blood, persistence of a thrombus for more than 7 days, and the impossibility of lowering intraocular pressure, despite maximum drug treatment.

Consequences and complications

Complications of hyphema can be:

• persistent decrease in visual acuity;
• glaucoma;
• complete or partial loss of vision;
• soaking the cornea of the eye with blood.

Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author

Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!