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Hyphema: diagnosis and management
1Wilmer Ophthalmologic Institute, Johns Hospital, Baltimore, Maryland 21205.
The management of traumatic hyphema has been controversial for many years. Treatments designed to prevent secondary hemorrhage have been proposed in the literature, then later abandoned when prospective studies failed to support them. In the last several years, published studies have demonstrated the efficacy of antifibrinolytic agents in the prevention of secondary hemorrhages. These studies have left unanswered some questions, however, such as whether antifibrinolytics are as effective in children as adults, in white patients as black, and in patients with normal hemoglobin as well as those with sickle cell hemoglobinopathies. The successful treatment of patients with hyphemas hinges on identification of risk factors, proper medical management and prompt surgical intervention when medical therapy fails.
The management of traumatic hyphema has been controversial for many years. Treatments designed to prevent secondary hemorrhage have been proposed in the literature, then later abandoned when prospective studies failed to support them. In the last several years, published studies have demonstrated the efficacy of antifibrinolytic agents in the prevention of secondary hemorrhages. These studies have left unanswered some questions, however, such as whether antifibrinolytics are as effective in children as adults, in white patients as black, and in patients with normal hemoglobin as well as those with sickle cell hemoglobinopathies. The successful treatment of patients with hyphemas hinges on identification of risk factors, proper medical management and prompt surgical intervention when medical therapy fails.
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