SANTANINA MUSAHARI, R.N.

—Frank bleeding into the anterior chamber

following contusion of the globe.

—Disruption of blood vessels in the iris or ciliary

body

—This blood usually does not clot

—w/ bed rest, a red fluid meniscus is form

• separates the cornea

from the lens, both

of which work

together to focus

light onto the retina.

The anterior chamber

is full of clear fluid

called aqueous

humor, which is

important for the

health of the cornea.

Blunt Trauma

Intraocular surgery

Lacerating trauma

Penetrating and perforating injury

It also occurs spontaneously w/o any trauma, usually neovascularization, tumor of eye (Retinoblastoma), uveitis or vascular anomalies

Use of medicine which impair blood clotting such as aspirin and analagesic

• Traumatic Hyphema occurs most often

from a tear in the anterior surface of the

ciliary body, with resultant disruption of

the major arterial circle of the iris,

arterial branches to the ciliary body or

vein coursing between the ciliary body

and episcleral venous plexus

• There are 2 suggested mechanism of

hyphema formation

– 1. direct contusive force cause mechanical

tearing of blood vasculature of iris and or

angle

– 2. Concussive trauma creating rapidly rising

intravascular pressure with in the vessels

resulting in rupture of vessels

- Blurring of vision

- Pain

- Photophobia

- Tearing

Grade Size of Hyphema

0 No layered blood

circulating red blood cells

only

I Less than 1/3

II 1/3 to 1/2

III 1/2 to less than total

IV Total

• Injured eye should be protected with a shield for 1 to 2 weeks after injury.

• Systemic Aminocaproic acid ( Amicar[100mg/kg of body weight every 4 hrs orally for 5 days], an inhibitor of fibrinolysis, may prevent early clot retraction within injured intraocular vessel and reduced the possibility of secondary hemorhhage.

• Spontaneous Recovery usually occur if the AC in not entirely filled w/ blood

• Minor rises in IOP

– Treated w/ topical timolol and systemic

acetazolamide.

• Surgical Indication:

– Inc. IOP of >50 mmHg

– Persistently (5 to 7 days) high pressure

– Early blood staining of the cornea

• Simple removal of small amount of aqueous

humour (Anterior Chamber Paracentesis) or

Irrigation of AC may be effective

– Clots should never be removed by means of forceps

due to difficulty distinguishing clot from iris.

– Vitrectomy irrigator aspirator maybe used to

aspirated the blood.

• Inserted through the corneoscleral limbus

• Care must be taken not to injure the endothelium, iris

or lens.

• General anesthesia is usually desirable due to

difficulty anesthetizing the congested eye

• If IOC is increase, give IV mannitol to reduced the

pressure before incision into AC

• Blood in the anterior chamber is not by it self

necessarily harmful. However, if the quantities

are sufficient it may obstruct the outflow of

Aqueous humour, resulting In Glaucoma

• The original hyphema, w/c is often relatively

minute and absorbed in 2 to 3 days, may be

followed by more severe bleeding 3 to 5 days

after the original injury. A secondary Glaucoma

may occur immediately.

• Secondary glaucoma– May cause optic atrophy, corneal blood staining

and adhesion between the peripheral iris and anterior chamber angle ( peripheral anterior synechiae.

– When anterior chamber is filled w/ blood, prolong secondary glaucoma causes staining of the cornea.• Corneal stroma is infiltrated by hemosiderin, w/c

causes deep yellowish green opacity of the cornea

• Aspirin and related analgesics w/c impair

blood clotting should not be used to

relieve pain

– Acetaminophen may be substituted.