hyphema & treatment regiment hyphema do hyphema · pdf filehyphema & treatment...

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Hyphema & Treatment RegimentHyphema & Treatment Regiment

Strict bed rest for at least 4 daysStrict bed rest for at least 4 days

Head elevated at 30 degreesHead elevated at 30 degrees

Pred Forte QIDPred Forte QID

CycloplegicCycloplegic

Mild analgesicMild analgesic

AmicarAmicar——forms clots fasterforms clots faster

Antiemetic may be neededAntiemetic may be needed

Manage elevated IOPManage elevated IOP’’ss–– b-blockers, alpha- b-blockers, alpha-agonistsagonists

Hyphema DoHyphema Do’’s and Dons and Don’’tsts

DonDon’’t perform gonioscopy initiallyt perform gonioscopy initially

Do take pressures by Do take pressures by applanationapplanation

-expect low immediately after the-expect low immediately after the

injury injury

-IOP remains low until CB regains-IOP remains low until CB regains

function, uveitis sets in or function, uveitis sets in or

secondary bleed secondary bleed

-can be a very difficult glaucoma to-can be a very difficult glaucoma to

manage manage

Never take pressures by digital Never take pressures by digital applanationapplanation

Do not perform scleral depression Do not perform scleral depression

Hyphema: DoHyphema: Do’’s and Dons and Don’’tsts

No aspirin useNo aspirin use

Do quantitate the amount of theDo quantitate the amount of thehyphemahyphema

Do see patient on a daily basis untilDo see patient on a daily basis untilresolutionresolution

Do inform patients to returnDo inform patients to returnimmediately for reevaluation if thereimmediately for reevaluation if thereis sudden pain or decreased visionis sudden pain or decreased vision

Do not patchDo not patch

Rebleed HyphemasRebleed Hyphemas

Tend to be much worse than primaryTend to be much worse than primary

bleedsbleeds

Viscous cycleViscous cycle

Consider the risk factors of bloodConsider the risk factors of blood

disordersdisorders

HEY!! What about ourHEY!! What about our

friend the Retina??friend the Retina??

Posterior Segment DamagePosterior Segment Damage

Results from impact over the scleraResults from impact over the sclera

or shock wavesor shock waves

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Posterior Segment DamagePosterior Segment Damage

Macular edemaMacular edema

Commotio retinaeCommotio retinae

Choroidal rupturesChoroidal ruptures

Evulsion of theEvulsion of theoptic nerveoptic nerve

Retinal tearsRetinal tears

Retinal dialysisRetinal dialysis

VitreousVitreoushemorrhagehemorrhage

Flashes and FloatersFlashes and Floaters

FlashesFlashes

HistoryHistory

–– What do they look like? Sparkles, flashWhat do they look like? Sparkles, flash

bulb, streaks?bulb, streaks?

–– When do you notice them most?When do you notice them most?

Evening, anytime, before onset of HA?Evening, anytime, before onset of HA?

–– Do you see floaters? Any change in sizeDo you see floaters? Any change in size

or number?or number?

–– Previous history of retinal tear or break?Previous history of retinal tear or break?

FloatersFloaters

HistoryHistory

–– New onset? How many? Which eye?New onset? How many? Which eye?

Describe them. Flashes? Any change inDescribe them. Flashes? Any change in

vision?vision?

Differential DiagnosisDifferential Diagnosis

Acute PVDAcute PVD

Acute retinal breakAcute retinal break

Ocular migraineOcular migraine

Posterior or Intermediate uveitisPosterior or Intermediate uveitis

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Acute PVDAcute PVD

May have associated vitreousMay have associated vitreous

hemorrhage or disc hemorrhagehemorrhage or disc hemorrhage

Symptoms Symptoms Floaters, Floaters, ““cobwebscobwebs””,,

blurred vision, move with eyeblurred vision, move with eyemovementsmovements

Documented scleral depressionDocumented scleral depression

SchafferSchaffer’’s signs sign

Follow up DFE in 4-6 weeksFollow up DFE in 4-6 weeks

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Acute retinal tear or breakAcute retinal tear or break

Horseshoe tear, operculated,Horseshoe tear, operculated,

symptomatic tearsymptomatic tear

Predisposing factors: Lattice,Predisposing factors: Lattice,

Retinoschisis, vitreal-retinal tuftRetinoschisis, vitreal-retinal tuft

Importance of scleral depressionImportance of scleral depression

Rule of thumbRule of thumb……pigment=tearpigment=tear

PVD

Horseshoe Tear

Lattice w/

holes

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Ocular migraineOcular migraine

Usually last 15-30 minutes, mostly femaleUsually last 15-30 minutes, mostly female

(60-70%)(60-70%)

Transient swirls, colors, wavesTransient swirls, colors, waves

Throbbing head pain, nausea, photophobiaThrobbing head pain, nausea, photophobia

Termed a classic migraine when HATermed a classic migraine when HA

followsfollows

Triggers: caffeine, chocolate, red wine,Triggers: caffeine, chocolate, red wine,

birth control, menopause, hormones,birth control, menopause, hormones,

fatigue, stress, refractive errorfatigue, stress, refractive error