Hyphaema
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Hyphaema refers to the presence of blood in the anterior chamber of the eye, typically resulting from trauma or underlying vascular abnormalities.
Aetiology
- Trauma-related: blunt or penetrating eye injury.
- Spontaneous: secondary to vascular abnormalities, sickle cell disease, or clotting disorders.
- Surgical complication: post-ocular surgery (e.g., cataract extraction).
- Neovascularisation: secondary to diabetes or retinal vein occlusion.
Pathophysiology
- Rupture of iris or ciliary body blood vessels leads to blood accumulation in the anterior chamber.
- Blood can clot and obstruct aqueous humour outflow, raising intraocular pressure.
- Rebleeding may occur within 3–5 days, increasing the risk of complications.
Risk Factors
- Ocular trauma (sports injuries, assaults).
- Bleeding disorders (haemophilia, von Willebrand disease).
- Sickle cell disease.
- Diabetic retinopathy.
Signs and Symptoms
- Red or dark fluid level in the anterior chamber: visible on slit-lamp examination.
- Blurry vision: due to blood accumulation affecting light transmission.
- Ocular pain: particularly if intraocular pressure is elevated.
- Photophobia: sensitivity to light.
Investigations
- Slit-lamp examination: confirms presence and grading of hyphaema.
- Intraocular pressure measurement: essential to assess secondary glaucoma risk.
- Ophthalmoscopy: evaluates for associated retinal or optic nerve damage.
- Full blood count and clotting screen: if an underlying bleeding disorder is suspected.
- Sickle cell testing: if relevant risk factors are present.
Management
1. Conservative Management:
- Head elevation: encourages blood resorption and prevents rebleeding.
- Avoidance of NSAIDs: to reduce bleeding risk.
- Protective eye shield: prevents further trauma.
2. Medical Management:
- Topical cycloplegics: atropine to prevent synechiae formation.
- Topical steroids: prednisolone eye drops to reduce inflammation.
- Intraocular pressure-lowering agents: acetazolamide or beta-blockers if required.
3. Surgical Management:
- Anterior chamber washout: in cases of uncontrolled intraocular pressure or persistent blood clotting.
4. Referral:
- Ophthalmology: all cases of hyphaema require urgent assessment.
- Haematology: if a bleeding disorder is suspected.