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Traumatic hyphema in children
P J Agapitos1, L P Noel, W N Clarke
1Department of Ophthalmology, Children's Hospital of Eastern Ontario, Ottawa.
Insights
Traumatic hyphema in children can lead to secondary hemorrhage in 7.6% of cases. While most children achieve good vision, secondary hemorrhage impacts visual outcomes, highlighting the need for careful management in pediatric eye injuries.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Trauma Care
Background:
- Traumatic hyphema is a significant eye injury in children.
- Understanding rebleeding risk and visual outcomes is crucial for pediatric eye care.
Purpose of the Study:
- To determine the incidence of secondary hemorrhage in pediatric traumatic hyphema.
- To evaluate visual outcomes and risk factors associated with rebleeding in children with traumatic hyphema.
Main Methods:
- Retrospective review of medical records for 316 children (ages 1-17) diagnosed with traumatic hyphema.
- Analysis of patient demographics, treatment, rebleeding rates, and long-term visual acuity.
- Calculation of traumatic hyphema incidence within a defined pediatric population.
Main Results:
- Secondary hemorrhage occurred in 7.6% of patients, with 3 requiring surgical intervention.
- Rebleeding risk did not correlate with age, topical steroid use, or cycloplegics.
- 91% of patients achieved 20/30 vision or better, compared to 77% of those with secondary hemorrhage. Amblyopia was rare.
Conclusions:
- Traumatic hyphema incidence is approximately 17 per 100,000 children annually.
- Secondary hemorrhage is a complication that can negatively impact visual prognosis in pediatric traumatic hyphema.
- Effective management strategies are essential to optimize visual outcomes in affected children.
Abstract:
The authors reviewed the medical records of 316 children admitted between January 1977 and March 1985 with a diagnosis of traumatic hyphema. In this group of patients, 1 to 17 years old treated without antifibrinolytics, the incidence of secondary hemorrhage was 7.6% (24 of 316 patients) of whom three required surgical evacuation of the clot. The risk of rebleeding did not correlate with the patient's age, use of topical steroids, or cycloplegics. Of 176 patients followed from 1 month to 7 years post-hospital discharge, 91% achieved 20/30 vision or better, but only 77% of the patients with secondary hemorrhage attained this level of vision. Amblyopia, a potential threat in young children, occurred in only two children both of whom also required cataract extraction. From our captive pediatric population of 228,000 the incidence of traumatic hyphema is 17 per 100,000 children per year.