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Blunt Injury: Hyphema


What is it?
You are looking at a hyphema—a hemorrhage in the bottom of the anterior chamber of the eye. The bleeding came from disruption of blood vessels at the iris root. It is a sign of severe ocular contusion.

There may be other signs of ocular contusion: corneal and retinal swelling, bleeding in the vitreous cavity, dislocation of the lens, rupture of the iris, cornea, retina, or sclera.

If the eye's surrounding tissues take the impact, there may be lid lacerations, orbital hemorrhage, and orbital bone fractures.

The immediate concern with blunt injury to the eye is whether the globe is intact. Did the cornea or sclera rupture? If so, an accessible wound must be repaired to restore normal intraocular pressure and prevent entry of micro-organisms.

The immediate concern about injury to the eye's surrounding tissues is a lid margin laceration through the inferior canaliculus. If this is not repaired so as to restore continuity of the canaliculus, the patient will probably have a tearing problem.

What to do?
Refer any patient with a hyphema emergently to an ophthalmologist.

If there has been a history of blunt injury to the eye, decide if the injury is serious by asking if pain is severe, finding out if visual acuity is subnormal, and looking for severe conjunctival ecchymosis, distorted globe, cloudy cornea, distorted pupil, hyphema, and absent red reflection through the pupil.

Decide if the injury to the eye's surrounding tissues is serious by looking for proptosis, lid margin lacerations, and reduced eye movements. If you suspect a lacerated globe, shield the eye.

Any of these findings is an indication for immediate ophthalmologic consultation.

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