What are the complications of hyphema (blood in the anterior chamber of the eye)?

From the Guidelines

Complications of hyphema include elevated intraocular pressure (IOP), corneal blood staining, peripheral anterior synechiae, and secondary glaucoma, which can lead to significant morbidity and mortality if not managed properly. These complications can arise due to the blockage of the trabecular meshwork by red blood cells or inflammatory debris, potentially requiring medications like topical beta-blockers, alpha-agonists, or carbonic anhydrase inhibitors 1. Rebleeding is a serious complication that typically occurs 2-5 days after the initial injury, increasing the risk of other complications.

Key Complications

• Elevated IOP: can occur due to red blood cells or inflammatory debris blocking the trabecular meshwork, potentially requiring medications like topical beta-blockers (timolol 0.5% twice daily), alpha-agonists (brimonidine 0.1-0.2% twice daily), or carbonic anhydrase inhibitors (dorzolamide 2% three times daily) 1
• Corneal blood staining: occurs when red blood cells penetrate the corneal endothelium, causing permanent discoloration if not addressed promptly
• Peripheral anterior synechiae: form when the iris adheres to the cornea or angle structures, potentially leading to angle-closure glaucoma
• Secondary glaucoma: can develop acutely or chronically due to trabecular meshwork damage

Management

Systemic medications like acetazolamide (250mg four times daily) may be needed for severe cases 1. Patients with sickle cell disease or trait are at higher risk for complications due to abnormal red blood cell morphology and require more aggressive management with lower IOP thresholds for intervention. Ghost cell glaucoma may occur weeks after hyphema when degenerated red blood cells obstruct aqueous outflow. Optic nerve damage can result from prolonged elevated IOP.

Prevention of Complications

Early detection and management of hyphema are crucial to prevent long-term complications and improve quality of life. Regular follow-up with an ophthalmologist is essential to monitor IOP, corneal staining, and optic nerve damage. In cases of rebleeding or severe complications, prompt surgical intervention may be necessary to prevent permanent vision loss.

From the Research

Complications of Hyphema

• Hyphema can lead to several complications, including:
  • Glaucoma 2, 3, 4, 5, 6
  • Corneal blood staining 2, 3, 4, 5, 6
  • Anterior and posterior synechiae 3, 4, 6
  • Increased intraocular pressure 2, 3, 4, 5, 6
  • Optic atrophy 3, 4, 5, 6
  • Rebleeding, which can increase the rate and severity of complications 4, 6
• People with sickle cell trait or disease may be particularly susceptible to increases in intraocular pressure and optic atrophy 4, 6

Risk Factors for Complications

• Delayed healing time and poor visual outcome are most often associated with hemorrhage filling more than one half of the anterior chamber 3
• Rebleeds are most likely 3 to 5 days following injury, in children, in blacks (particularly if they have sickle cell disease), and in persons who have ingested aspirin or other antiplatelet compounds 3

Management of Complications

• Medical therapy, such as antibiotics, cycloplegics, steroids, and aminocaproic acid, should be tailored to suit the needs of each case 3
• Intraocular pressure-reducing medications may be required if there is significant elevation of IOP 3
• Surgical intervention may be necessary in some cases, such as large hyphemas or those with significant complications 5