From the Research
Complications of hyphema include rebleeding, increased intraocular pressure (IOP), corneal blood staining, peripheral anterior synechiae, and optic atrophy, with rebleeding typically occurring within 2-5 days after the initial injury and carrying a worse prognosis than the original hyphema. These complications can lead to permanent vision loss if not properly managed. According to the most recent and highest quality study 1, the use of antifibrinolytic agents such as systemic aminocaproic acid or tranexamic acid may reduce the rate of secondary hemorrhage, but the evidence is limited by the small number of events.
Some key points to consider in the management of hyphema include:
- Controlling IOP with medications like topical beta-blockers, alpha-agonists, or oral carbonic anhydrase inhibitors, while avoiding prostaglandin analogs which may increase inflammation
- Surgical intervention may be necessary for hyphemas occupying more than 50% of the anterior chamber, persistent elevated IOP despite medical therapy, or corneal blood staining
- Patients with sickle cell disease or trait require more aggressive management as they're at higher risk for complications due to sickling of erythrocytes in the relatively acidic and hypoxic anterior chamber environment
- The use of antifibrinolytic agents may be associated with increased nausea, vomiting, and other adverse events compared with placebo
It's also important to note that the evidence supporting the use of corticosteroids, cycloplegics, or non-drug interventions (such as patching, bed rest, or head elevation) in the management of traumatic hyphema is limited, and further research is needed to assess the additive effect of these interventions 1.
In terms of specific management strategies, the use of systemic tranexamic acid has been shown to reduce the rate of secondary hemorrhage (RR 0.33,95% CI 0.21 to 0.53) in seven trials with 754 participants 1. However, the evidence is limited, and more research is needed to fully understand the effectiveness of this intervention.
Overall, the management of hyphema requires careful consideration of the potential complications and the use of evidence-based interventions to minimize the risk of long-term vision loss.