Hyphema

Description

• A grossly visible collection of blood in the anterior chamber of the eye
• Microhyphema refers to red blood cells in the anterior chamber which do not layer out and are not grossly visible.
• Traumatic hyphema is a common complication of blunt or penetrating trauma to the eye that can result in permanent vision loss.

Epidemiology

Incidence
Annual incidence of 20 cases per 100,000 population (1)
Prevalence

• Up to 70% occur in children with a peak incidence at 10 to 20 years of age.
• Males are affected 3 to 5 times more often than females (1).

Etiology and Pathophysiology

• Blunt trauma is the most common cause, and assault is the most common mechanism.
• Penetrating trauma
• Postoperatively following intraocular surgery
• Neoplasm (retinoblastoma or iris melanoma)
• Clotting disorders (von Willebrand disease or juvenile xanthogranuloma)
  • Pathophysiology: Posterior displacement of tissue stretches the limbal vessels resulting in a tear and lead to bleeding; red blood cells obstruct outflow of aqueous humor and remain in the anterior chamber.

Risk Factors

• Trauma
• Congenital bleeding disorders (sickle cell trait or disease)
• Anticoagulation
• Intraocular surgery

Commonly Associated Conditions

Blood dyscrasias such as sickle cell disease