What is the treatment for hyphema (blood in the anterior chamber of the eye)?

From the Research

The treatment of hyphema should prioritize the use of topical tranexamic acid to reduce the risk of rebleeding, as evidenced by the most recent study 1. The management of traumatic hyphema involves a combination of medical and surgical interventions to prevent complications and promote resolution. Initial management includes bed rest with the head elevated at 30-45 degrees to allow blood to settle, along with eye protection using a shield to prevent further trauma. Some key points to consider in the treatment of hyphema include:

• Medical therapy typically involves topical steroids such as prednisolone acetate 1% four times daily to reduce inflammation, and cycloplegics like atropine 1% twice daily to reduce pain and prevent synechiae formation.
• For patients with elevated intraocular pressure, topical beta-blockers (timolol 0.5% twice daily) or alpha-agonists (brimonidine 0.2% twice daily) may be used, while avoiding prostaglandin analogs which can increase inflammation.
• Oral medications like acetazolamide 250mg four times daily can help control pressure if topical treatments are insufficient.
• Patients should avoid aspirin and NSAIDs which can increase bleeding risk.
• Most hyphemas resolve within 5-7 days with conservative management, but surgical intervention may be necessary for hyphemas that are large (>50% of anterior chamber), have persistent elevated intraocular pressure despite medical therapy, or show corneal blood staining.
• The use of systemic prednisolone versus topical tranexamic acid for prevention of rebleeding in patients with traumatic hyphema has been compared in a recent study 1, which found that topical tranexamic acid appears promising in the management of macroscopic traumatic hyphema.
• Another study 2 found that systemic aminocaproic acid reduced the rate of recurrent hemorrhage, and systemic tranexamic acid had a significant effect in reducing the rate of secondary hemorrhage.
• However, the most recent and highest quality study 1 should be prioritized, which recommends the use of topical tranexamic acid to reduce the risk of rebleeding. Close monitoring is essential, with daily examinations initially to assess for complications like rebleeding (most common 2-5 days after initial injury), corneal blood staining, or secondary glaucoma which can lead to permanent vision loss if not properly managed.