hyphema

A 28-year-old male presented to the ED for evaluation of an injury to his right eye. While working out with an exercise band, it snapped back, hitting the patient in the right eye. He experienced blurry vision and excess eye tearing immediately after the incident occurred. The patient also developed gross blood over the front of the eye.

Vitals: Temp 98°F, HR 73, BP (135/77), RR 16, SpO2 99%

HEENT: Gross blood in the anterior portion of the right eye (grade I). The right pupil is dilated with minimal responsiveness to light. Visual Acuity: OD 20/70, OS 20/10, Both 20/10. Pressure: OD (21), OS (16). Decreased visual field on the right when compared to the left. Staining with tetracaine and fluorescein did not reveal any evidence of corneal abrasion or ulceration. Left eye is atraumatic in appearance.

Neurologic: Alert and oriented x3

Non-contributory

A Hyphema is a collection of blood in the anterior chamber of the eye due to the tearing of the iris root vessels.

The most common cause is blunt trauma to the eye. Spontaneous hyphemas can also occur and are often associated with sickle cell disease. It can be caused by ocular surgery and neoplastic disease, as well.

Take-Home Points

  • Hyphemas are an ocular emergency and should prompt immediate consultation with an ophthalmologist.
  • Patients should elevate the head of the bed to 45 degrees since layering of the blood is gravity-dependent.
  • Treatment usually involves the administration of steroidal and cycloplegic ophthalmic drops.

  • Cline, D., Ma, O. J., Meckler, G. D., Stapczynski, J. S., Thomas, S. H., Tintinalli, J. E., & Yealy, D. M. (2020). 241. In Tintinalli’s emergency medicine: A comprehensive study guide. essay, McGraw-Hill Education.
  • Traumatic Hyphema. Wikem. (2020, March 18). Retrieved January 11, 2023, from https://www.wikem.org/wiki/Main_Page

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

Thelmari Raubenheimer, DO

Thelmari Raubenheimer, DO

Resident Physician
Grand Strand Medical Center
Thelmari Raubenheimer, DO

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