Outpatient treatment of microscopic and rim hyphemas in children with tranexamic acid

Area of Science:

• Ophthalmology
• Pediatric Medicine
• Pharmacology

Background:

• Hyphema, or blood in the eye's anterior chamber, poses a risk of secondary hemorrhage.
• Pediatric hyphema management traditionally involves bed rest and cycloplegia.
• Systemic tranexamic acid is an antifibrinolytic agent with potential for managing hyphema.

Purpose of the Study:

• To evaluate the efficacy of systemic tranexamic acid in preventing secondary hemorrhage in pediatric hyphema patients.
• To assess the safety and tolerability of this outpatient treatment protocol.
• To identify the incidence of associated ocular injuries in this cohort.

Main Methods:

• Outpatient treatment of 21 pediatric patients (ages 4-15) with microscopic or rim hyphema.
• Administered systemic tranexamic acid therapy.
• Implemented a protocol of limited activity, topical steroids, no dilating drops, and patching for comfort.

Main Results:

• No instances of secondary hemorrhage were observed in any treated patients.
• A high incidence of associated ocular injuries was noted, including angle recession, choroidal ruptures, and commotio retinae.
• Two patients with commotio retinae required cryotherapy for retinal holes.

Conclusions:

• Systemic tranexamic acid therapy is effective in reducing the risk of secondary hemorrhage in ambulatory pediatric hyphema patients.
• Close monitoring and comprehensive eye examinations are essential to detect associated ocular trauma.
• This outpatient regimen offers a promising approach to managing pediatric hyphema while minimizing complications.