Hyphaema

It’s 2pm on a Saturday and the regular crowd shuffles in. Sorry that’s a Billy Joel song. It’s 2pm on a Saturday and a 23 year old male presents after being struck in the eye by a squash ball. You quickly look and it’s a ……….HYPHAEMA.

A hyperaemia is defined as blood in the anterior chamber of the eye.

3 THINGS TO CONSIDER.

1 How do we grade Hyphaemas?

Grade 1   <1/3 of the anterior chamber has blood in it

Grade 2   1/3 – 1/2 of the anterior chamber has blood in it

Grade 3   >1/2 of the anterior chamber has blood in it, but it is not totally filled.

Grade 4   Total filling of the anterior chamber

2 How do we, in the ED, treat patients with hyphaemas?

-Shield the eye(not patch)

-Rest the eye- no watching TV or reading. Pupillary changes must be minimised.

-Sedation sometimes assists.

-Analgesia

-Sitting at a 30-45 degree angle may improve the settling. It can result in earlier clearing and more rapid improvement of visual acuity.

3 What to beware of?

-Always test visual acuity and Afferent Pupillary defect

-Raised intraoccular pressure occurs in about 1/3 of cases

-Secondary bleeding occurs in 25% of cases and results in worst prognosis in terms of visual acuity.

-BEWARE with this history NOT TO MISS THE GLOBE RUPTURE.

4 What are the potential complications?

     -Rebleeding

-Optic Atrophy

-Corneal Staining

-Ghost Cell Glaucoma- the red blood cells lose their haemoglobin and block the trabecular meshwork.

Who can we discharge?

Patients with Grade I hyphaemas and no other complications can go home

Who needs ophthalmology?

Grade 4 hyphaemas, raised intraoccular pressure, or anyone with sickle cell disease or trait.

Peter Kas