Incidence, Risk Factors, and Visual Outcomes of Ocular Hypertension in Pediatric Traumatic Hyphema

To determine the incidence, risk factors, and final visual outcomes of ocular hypertension (OHT) following pediatric closed-globe traumatic hyphema, and to provide a rapid assessment guideline for non-ophthalmologist pediatric providers in risk-stratifying traumatic hyphema patients.

This retrospective cohort included patients <18 years with closed-globe hyphema (2003-2023) across 3 tertiary centers. OHT was defined as intraocular pressure >21 mmHg post-injury. Visual impairment and blindness were classified using World Health Organization criteria. Multivariable logistic regression identified risk factors.

Among 196 eyes, the mean age at presentation was 11.2 ± 4.7 years, with a male predominance (77.6%). Toy/BB guns were the leading cause (32.1%) of traumatic hyphema. After a mean follow up of 13.9 ± 15.2 months, OHT developed in 93 eyes (47.4%); 61.3% were medically managed, while the remainder required surgery. Clinically recognizable and significant risk factors for developing OHT included sickle cell spectrum (adjusted odds ratio [AOR] 29.9, P=0.001), high-grade hyphema (defined by obscured pupil; AOR 6.6, P=0.024), and visual acuity on presentation worse than 20/200 (unable to read Snellen chart; AOR 4.0, P=0.005). By day 3 post-injury, OHT risk increased to 25%, 24.7%, 53.8%, 68.7%, and 77.8% across grades 0-4 hyphema, respectively. Blindness occurred more frequently in eyes with OHT requiring surgical treatment (13.9%) compared with eyes without OHT (2.9%).

OHT is a common complication of pediatric traumatic hyphema and predicts poorer visual outcomes, especially when surgery is required. Early recognition and referral of high-risk cases and preventive measures against toy-related eye trauma are essential.