Ocular morbidity of traumatic hyphema in a Jamaican hospital.

PURPOSE: To determine the outcome of patients with hyphema secondary to ocular contusion. METHOD: A retrospective review of the ophthalmic records of 44 consecutive patients with traumatic hyphema secondary to ocular trauma presenting to the Eye Clinic of the University Hospital of the West Indies between May 2004 and November 2007. RESULTS: The mean age was 21 years (95% confidence interval [CI] 16.4-25.5 years). Follow-up ranged from 2 weeks to 22 months. The most common mechanism of injury was impact by a missile and 41% occurred at home. The mean visual acuity at presentation was logMAR 1.85 (95% CI 1.4-2.3) and at 3 months improved to logMAR 0.63 (95% CI 0.3-1.0). The presenting intraocular pressure (IOP) ranged from 7-64 mmHg with 45.4% (20/44) having IOP of greater than 21 mmHg; 18% had the sickle cell trait. A total of 72.7% of patients presented with a grade I hyphema. Surgical intervention was indicated in 20.5% (9/44), which included anterior chamber paracentesis/washout and trabeculectomy. The most frequent complications were secondary glaucoma (32.4%), angle recession (23.5%), cataract (20.6%), and commotio retinae (20.6%). In the sickle cell group, 80% presented with elevated IOP (29-64 mmHg) and 70% had complications. A total of 94.7% of patients had an IOP <21 mmHg at 3 months. CONCLUSIONS: Traumatic hyphema is a recognized cause of significant visual disability. Improved visual acuity was attained after 3 months. The presenting visual acuity correlated with the visual prognosis. Patients with posterior segment complications tended to have poorer visual outcomes. The presence of the sickle cell gene increased the risk of secondary glaucoma.

[Ocular injuries in mild facial trauma]. / Atteintes oculaires lors d'un traumatisme léger de la face.

Ocular contusions are common and cause significant morbidity. The mechanism of ocular contusion is a decrease in the length of the anterioposterior axis whereas the transversal axis increases. Epidemiology data shows that young men are most injured in relation with sports, aggression, work, or car or work accidents. Injury to the ocular surface (conjunctiva and cornea) is minor. The iris is very frail, usually leading to hyphema which can progress to glaucoma. A cataract can appear after a contusion but usually years after the trauma. Final visual acuity can be compromised by retinal contusion or retinal detachment (due to a retinal dehiscence or post-traumatic dialysis). The worst outcome is optic neuropathy. The most difficult task is to predict visual acuity after the initial ocular lesion.

Outpatient management of traumatic hyphema in children: prospective evaluation.

PURPOSE: To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis. METHODS: A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded. RESULTS: Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P < 0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%). CONCLUSIONS: Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.

Characteristics and functional outcome of traumatic hyphema without routine administration of epsilon-aminocaproic acid.

BACKGROUND: The prevalence of traumatic hyphema as well as the distribution of its severity varies among different patient populations. Treatment recommendations in the literature differ significantly among various published reports. This lack of a uniformly accepted treatment probably reflects the different characteristics of this pathology among the populations investigated and cells for a population-adjusted treatment recommendation. OBJECTIVES: To report the characteristics and functional outcome of patients with traumatic hyphema and to discuss possible recommendations regarding the use of epsilon-aminocaproic acid. METHODS: A prospective, non-randomized study was conducted in 154 consecutive patients with traumatic hyphema, including data collection of ophthalmic status at various time points, the presence or absence of secondary hemorrhage, and final visual acuity. RESULTS: Of the 154 eyes studied over 3 years, nearly 90% had hyphema of grade 1 or less, 5 (3.25%) experienced rebleeding, and 2 (1.3%)--neither of which rebled--needed surgical intervention. None of the four patients who experienced final visual acuity of 6/40 or less suffered rebleeding. CONCLUSION: The use of epsilon-aminocaproic acid in the studied population was unjustified and routine use of epsilon-aminocaproic acid in our patient population is probably not indicated. A treatment policy regarding epsilon-aminocaproic acid use should be adjusted to the population being treated.

[Traumatic hyphema due to contusion. 40 cases]. / Hyphéma traumatique par contusion. A propos de 40 cas.

PURPOSE: To study the clinical characteristics of traumatic hyphema and to discuss the place of medical and surgical treatment. MATERIAL AND METHODS: A retrospective study of 40 patients hospitalized between 1991 and 1995 for traumatic hyphema was conducted. RESULTS: The average age of patients was 16 years. There were 87.5% males. Sex ratio was 7.1. Dangerous games were responsible for injury in 40% of cases. 60% were grade 2 or less. With medical treatment, outcome was favorable in 67.5% of eyes with hyphema, often within 2 to 5 days. However, complications occurred in 35% of cases: secondary hemorrhage, ocular hypertony, blood staining of the cornea and posterior synechiae. Only 4 cases needed surgical treatment. 3 of them developed secondary hemorrhage after surgery. CONCLUSION: Traumatic hyphema is a diagnostic and therapeutic emergency. More preventive efforts are needed especially in children. Outcome is generally good if medical treatment was quickly instituted. Surgical treatment must be reserved for cases with refractory persistant hypertony, because of the risk of secondary bleeding.

Pronóstico visual en el hipema traumático / Visual prognosis in traumatic hypema

Se presenta el estudio del hipema traumático en 82 ojos con trauma cerrado (contusiones), en que relacionan los grados del mismo con la agudeza visual inicial y final, lesiones asociadas en el segmento anterior y posterior y con los estudios electrofisiológicos: electrorretinograma (ERG) y potenciales evocados visuales (PEV). Los resultados demostraron una relación directa entre los grados del hipema y la agudeza visual final con el 27 por ciento de los ojos ciegos en el grado III, un incremento en el número y gravedad de las lesiones asociadas en el hipema grado III y una respuesta electrofisiológica (ERG y PEV) deteriorada. LOs autores concluyen que el grado del hipema guarda relación directa o indirecta con el grado y la gravedad del traumatismo pudiendo considerarse como un indicador de pronóstico

Pronóstico visual en el hipema traumático / Visual prognosis in trauatic hypema

Se presenta el estudio del hipema traumático en 82 ojos con trauma cerrado (contusiones), en que relacionan los grados del mismo con la agudeza visual inicial y final, lesiones asociadas en el segmento anterior y posterior y con los estudios electrofisiológicos: electrorretinograma (ERG) y potenciales evocados visuales (PEV). Los resultados demostraron una relación directa entre los grados del hipema y la agudeza visual final con el 27 por ciento de los ojos ciegos en el grado III, un incremento en el número y gravedad de las lesiones asociadas en el hipema grado III y una respuesta electrofisiológica (ERG y PEV) deteriorada. LOs autores concluyen que el grado del hipema guarda relación directa o indirecta con el grado y la gravedad del traumatismo pudiendo considerarse como un indicador de pronóstico (AU)

Outcome of traumatic hyphema.

One hundred and twenty-seven cases of traumatic hyphema are reviewed and discussed according to a definite system of grading. Grade iii hyphemas have definitely a poorer prognosis than Grade ii and Grade i hyphemas. Rebleeding occurs more frequently when there is a delay in treatment but does not appear to affect the outcome of a traumatic hyphema. Blood staining of the cornea could be avoided by an adequate treatment started immediately after the trauma, thus decreasing the percentage of blindness following a traumatic hyphema.